1/49. Papillary transitional cell carcinoma of the breast: a report of five cases with distinction from eccrine acrospiroma.Papillary carcinomas of the female breast exhibit a spectrum of morphologic appearances and might be mistaken for benign intraductal papillary lesions or papillary adnexal neoplasms. We report herein five cases of papillary carcinoma in which the epithelium closely resembled transitional cells of the urinary bladder. Grossly, the tumors had a nodular or papillary appearance, white, tan, or red in color. The microscopic features were those of an intraductal papillary proliferation of solid layers of epithelial cells overlying fibrovascular cores. The proliferating cells assumed a whorled or streaming growth pattern, with flattening of superficial cells. One case showed microinvasion. Comparison with a similar number of cases of the solid variant of papillary carcinoma of the breast showed a greater range of nuclear pleomorphism, mitotic counts, and a more varied immunohistochemical profile in the papillary carcinomas with transitional cell features. Eight cases of eccrine acrospiroma occurring in the female breast also displayed a solid or solid papillary pattern, with flattened superficial cells. These occurred in a younger age group, were located in the dermis or subcutis, and usually had zones of clear cells visible at low magnification. No evidence of recurrent or metastatic disease was found in the four patients for whom follow-up was available; the length of follow-up ranged from 18 months to 11 years. The stimulus for the development of this unusual phenotype is unclear, but the transitional-like variant seems to behave in a fashion similar to that of other types of papillary carcinoma of the breast. Distinction of this malignant lesion from various benign lesions that occur in the same region is mandatory.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/49. Intra-abdominal abscess due to patient non-compliance after construction of an ileal neobladder: case report and review of the literature.PURPOSE: A case report of patient with an intra-abdominal abscess 8 weeks after radical cystectomy and construction of an ileal neobladder is presented. methods/RESULTS: The patient was admitted with nausea, vomiting and singultus. A perforation of the neobladder due to overdistension was assumed to be the underlying cause of the intra-abdominal abscess formation as the patient admitted infrequent voiding during the day and no emptying of the neobladder at night. The patient underwent explorative laparotomy and 4200 mL of pus was removed from the abdominal cavity. The patient made an uneventful recovery and was discharged from hospital after 5 weeks. Neobladder function remained stable and the patient was leading a normal life at 24 months follow-up. CONCLUSIONS: The present case demonstrates the need for careful patient selection prior to radical cystectomy with continent urinary diversion. Reduced compliance and mental disabilities of a patient can increase the complication rate.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
3/49. airway obstruction due to late-onset angioneurotic edema from angiotensin-converting enzyme inhibition.PURPOSE: Angioneurotic edema is a well-documented complication of angiotensin-converting enzyme inhibitors (ACEI). We report a case of acute airway obstruction from a late-onset, probable ACEI-related angioneurotic edema and its subsequent management. CLINICAL FEATURES: A 48-yr-old obese man presented for transurethral resection of a bladder tumour (TURBT). His past medical history included hypertension controlled with hydrochlorothiazide and quinapril which had been started 13 mo earlier. Previous surgery was uncomplicated. midazolam was used for premedication and for intraoperative sedation together with fentanyl and propofol. After uneventful spinal anesthesia with bupivacaine, operation and recovery, he was transferred to the floor. Five hours later he developed severe edema of his face, tongue and neck, with drooling, that progressed into airway obstruction and respiratory arrest. ventilation was restored via immediate cricothyroidotomy, and a subsequent tracheotomy was completed uneventfully in the operating room. His serum C1 esterase inhibitor levels at 1, 5 and 23 days later were normal. The angioneurotic edema was attributed to the ACEI treatment. The edema resolved after 48 hr, and further follow-up was unremarkable. CONCLUSION: This observation is consistent with other reports that angioneurotic edema from ACEI can occur many months after the initiation of treatment. This can involve the airway and may produce life-threatening respiratory compromise. physicians should be aware of this association and the possible need for immediate surgical intervention for the establishment of an airway in case of worsening edema or respiratory arrest.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
4/49. hepatitis in disseminated bacillus Calmette-Guerin infection.Local immunotherapy with an attenuated live strain of mycobacterium bovis, bacillus Calmette-Guerin (BCG), is an effective and frequently used treatment for in situ transitional cell carcinoma (TCC) of the bladder. Success rates are high, and serious side effects are infrequent but can affect every organ system. A 79-year-old patient with recently diagnosed TCC who was treated with intravesical BCG for a recurrence after initial surgical treatment is reported. After unsuccessful attempts at bladder catheterization with the creation of a false passage for his third treatment, BCG was instilled via a suprapubic catheter the same day and again a week later. Two weeks after the third BCG instillation, the patient presented with profound lethargy and weakness to the point of not being able to get up out of a chair. He was febrile, anorexic, icteric and had hepatosplenomegaly. Disseminated BCG infection was suspected on the basis of history, clinical examination and a liver biopsy that showed noncaseating granulomatous hepatitis. Empirical treatment was started with antituberculous combination therapy. A short course of an oral corticosteroid was given. Clinical improvement was marked and sustained so that the patient could be discharged home for the full six-month course of his treatment. Disseminated BCG infection with granulomatous hepatitis can be severe and life-threatening in cases where a large intravascular inoculum of BCG may have been given inadvertently.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
5/49. Primary synovial sarcoma of the kidney: Report of a case confirmed by molecular detection of the SYT-SSX2 fusion transcripts.We describe an unusual case of primary synovial sarcoma of the kidney. A 47-year-old woman had a tumor massively replacing the right kidney. There were no primary extrarenal neoplastic lesions. Microscopically, the tumor was composed of a cellular proliferation of relatively uniform spindle-shaped cells having atypical spindle or oval nuclei arranged in fascicles with tumor necrosis, without epithelial areas. Immunohistochemically, a small number of the tumor cells were positive for epithelial markers such as cytokeratin and epithelial membrane antigen. The SYT-SSX2 fusion transcripts were detected by a reverse transcription-polymerase chain reaction (RT-PCR) using RNA extracted from formalin-fixed, paraffin-embedded tissue. ETV6-NTRK3 fusion gene transcripts that result from t(12; 15)(p13;q25), which is characteristic of cellular congenital mesoblastic nephroma, were not demonstrated. To our knowledge, this is the ninth case of primary renal synovial sarcoma. This case report indicates that synovial sarcoma should be taken into account for the differential diagnosis of renal spindle cell tumors and the molecular assay detecting the SYT-SSX fusion transcripts is useful for the final diagnosis of synovial sarcoma arising in an unusual location.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
6/49. The treatment of bilateral synchronous renal pelvic tumors with Bench surgery.Bilateral nephrectomy, renal perfusion and bench surgery have been used in the management of synchronous bilateral renal pelvic tumors in a 35-year-old man. The possibility of bilateral nephrectomy followed by hemodialysis and eventual transplantation was considered but was not done because we believe for the present time that the nature of the immune response and its importance in the pathogenesis of cancer are complicated and poorly defined. It is likely that immunosuppression may tip the balance toward the tumor. Bench surgery allowed us to perform radical resection of these urothelial tumors yet preserve enough renal tissue to sustain life. This patient is now enjoying an active life and has a blood urea nitrogen of 30 mg. per cent and a serum creatinine of 1.2 mg. per cent from the functioning third of the former right kidney.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
7/49. Histopathologic and biologic characteristics of a transitional cell carcinoma with inverted papilloma-like endophytic growth pattern.To evaluate histopathologic and biologic characteristics in a patient with transitional cell carcinoma (TCC) with an endophytic growth pattern similar to that seen in an inverted papilloma. Although the tumor surface was mostly covered with normal-looking urothelium, the covering layer was thicker in parts than in those of benign papillomas. The widths of the trabeculae were irregular, and cytologic atypia with remarkable mitosis was seen. High expression of p53, Ki67, and cytoplasmic cyclin d1 was demonstrated by immunohistochemical staining. To clarify the biologic activities of tumors with inverted papilloma-like growth pattern, even when it appears as benign lesions by routine pathologic examination, analyses of immunoreactivity for proliferation markers might be critical.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
8/49. Transitional cell carcinoma involving the ureterovesical part of a transplanted ureter.Ureterovesical malignancy in the renal transplant recipient is an infrequent occurrence. We report a woman with a cadaver kidney recipient, transplanted 10 years ago, with transitional-cell carcinoma at the ureterovesical part of the transplanted ureter invading the bladder muscle around the orifice. Though aggressive surgery and chemotherapy of such patients is proposed, most patients die after an average of 16-17 months. In our patient we have done partial ureter and bladder resection in order to preserve kidney graft and bladder. We continued immunosuppressive treatment. The patient has survived 16 months and is symptom free. Our case suggests that nonaggressive operative treatment without chemotherapy in selected patients may provide comparable survival to patients with aggressive treatment, but with better quality of life.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
9/49. BCG therapy in superficial bladder tumours--complications and precautions.bacillus Calmette-Guerin (BCG) immunotherapy represents a valuable treatment in the management of superficial bladder cancer, but the therapy is not without its risks. A total of 220 patients have been included in a review of local and systemic side effects associated with BCG immunotherapy. The majority of side effects are mild and self limiting, but potentially life threatening complications can arise with BCG immunotherapy. These systemic side effects include pneumonitis/hepatitis and systemic BCG infection. Recommendations are given for the use and administration of BCG, and if these rules are correctly applied, BCG may be administered safely, and with confidence.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
10/49. Urethral recurrence after sigmoid orthotopic neobladder. What should be the ideal treatment approach?Orthotopic neobladder reconstruction has become a standard procedure in patients undergoing radical cystectomy for invasive bladder cancer. In addition the known sequelae like nocturnal enuresis, need of self-intermittent catherisation and stricture at urethro or ureteroileal anastomosis, one of the most unfortunate event to happen is the recurrence of malignancy that may require the removal of the neobladder lessening the quality of life suddenly. There is a little information about the cases of urethral recurrence of transitional cell carcinoma of the bladder after cystectomy and orthotopic neobladder. We report such a case and management dilemma as the patient is young and does not want to loose body image and a brief review of literature is presented.- - - - - - - - - - ranking = 0.5keywords = life (Clic here for more details about this article) |
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