Cases reported "Urogenital Neoplasms"

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1/15. Vaginal reconstruction using a vertical rectus abdominis myocutaneous flap in a child: a case report.

    rhabdomyosarcoma is the most common soft tissue sarcoma in infants and children younger than 15 years old. Multimodal treatment using chemotherapy, radiation, and surgery have increased survival. Because of the potential for long-term survival, the importance of organ preservation and vaginal and pelvic reconstruction has been recognized. The authors report a case in which special circumstances led to vaginal reconstruction concomitantly with exenteration surgery. The authors present the first reported use of a vertical rectus abdominis myocutaneous flap in a child and describe the technique and its potential advantages.
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2/15. Cutaneous metastases from genitourinary malignancies.

    OBJECTIVES: To review the world literature for reports of cutaneous metastases from primary genitourinary malignancies and compare them with our experience during a 10-year period. Cutaneous metastases from primary visceral malignancies are uncommon manifestations of advanced disease. Among patients with urologic malignancies, the incidence and appearance of cutaneous metastases are not well established and recognition is poor among practicing urologists. methods: A medline search and manual bibliographic review was performed to identify peer-reviewed reports pertaining to cutaneous metastases from all visceral malignancies. A comparative review of all pertinent cases arising from primary urologic malignancies was performed. A comprehensive search of our institution's tumor registry was performed to identify all analytic cases of urologic malignancy diagnosed, treated, and followed up between 1990 and 2000. Clinical and pathologic data were collated. RESULTS: We identified 2,369 reported cases of cutaneous metastases arising from 81,618 primary solid visceral malignancies, for an overall incidence of 2.9%. Dermatologic spread from primary urologic malignancies of the kidney, bladder, prostate, or testes was noted in 116 (1.3%) of 10,417. The incidence of cutaneous metastases from the kidney, bladder, prostate, and testes was 3.4%, 0.84%, 0.36%, and 0.4%, respectively. overall, 436 cases of cutaneous metastases from urologic organs were identified in the English-language literature. We identified nine additional cases of pathologically confirmed cutaneous metastatic urologic tumors at our institution in the past 10 years. The most common presentation was an infiltrated plaque or nodules. Most cases displayed clinical features that mimicked common skin disorders. The median disease-specific survival was less than 6 months from the presentation of cutaneous metastasis. CONCLUSIONS: Cutaneous metastases from urologic tumors are uncommon and occur in 1% of patients with advanced disease. Urologic skin metastases are most common from renal tumors, followed by those of the bladder and then prostate. Their clinical appearance may mimic other common dermatologic disorders affecting patients with advanced malignancies. Definitive diagnosis requires an index of suspicion and skin biopsy. Cutaneous metastases from urologic malignancies are associated with a poor prognosis.
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3/15. Diversity of organ site involvement among malignant lymphomas of mucosa-associated tissues.

    Fifteen cases of low-grade B-cell lymphoma involving unusual extranodal sites have been studied in comparison to cases reported or observed arising in typical mucosa-associated lymphoid tissues. In every case, histopathologic features conformed to those characteristic for lymphomas of mucosa-associated lymphoid tissues, including the production of lymphoepithelial complexes. Immunoglobulin light chain restriction was demonstrated by immunocytochemistry in 14 cases. Sites of involvement included the breast (6), skin (5), kidney (1), prostate (1), gallbladder (1), and uterine cervix (1). In three cases there was simultaneous or previous lymphoma of mucosa-associated lymphoid tissues identified in a more common mucosal site. It is concluded that the unifying concept of lymphomas of mucosa-associated lymphoid tissues applies to extranodal organs less commonly associated with mucosa-associated lymphoid tissues, as well as to those mucosal organ sites described in earlier series.
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4/15. A heparin-like anticoagulant as part of global abnormalities of plasma glycosaminoglycans in a patient with transitional cell carcinoma.

    A patient is described in whom a circulating heparin-like anticoagulant developed during the terminal course of metastatic transitional cell carcinoma. The anticoagulant, which was identified as heparan sulfate, was the clinical sign of global abnormalities in the patient's plasma glycosaminoglycans. Subsequent analysis disclosed increased amounts of chondroitin sulfate as well as heparan sulfate. In addition, the charge density and molecular weight of the patient glycosaminoglycans and their organization into proteoglycans differed significantly from glycosaminoglycans isolated from normal plasma samples.
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5/15. sexuality and fertility in urologic cancer patients.

    With the advent of effective treatment for urologic cancer, the preservation of sexual function and fertility has become an important goal. Some cancer treatments damage the physiological systems involved in reproduction. All have a psychological impact on sexuality. For men with prostate cancer, current issues in sexual rehabilitation include the debate on nerve-sparing radical prostatectomy, the role of vascular damage in causing erectile dysfunction after radiotherapy, and the need for a better understanding of hormonal effects on central and peripheral mechanisms of sexual function. In the treatment of men and women with bladder cancer, the sexual function morbidity of radical cystectomy is described in data from prospective interview studies. Sexual desire and orgasm remain normal after surgery despite disruption of the genital vasocongestion accompanying sexual arousal. Long-term follow-up studies of testicular cancer patients suggest that some increase in sexual dysfunction does occur. infertility remains a concern for a subgroup of younger, childless men. Attempts to modify or eliminate retroperitoneal lymphadenectomy are discussed, as is recovery of spermatogenesis after chemotherapy and radiotherapy. Sexual function in patients with penile, urethral, or renal cell carcinoma is briefly reviewed.
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6/15. Triple urogenital cancer in a patient with a history of heavy smoking who had been exposed to the Hiroshima atomic bomb explosion.

    A survivor of the Hiroshima atomic bomb experienced triple cancer of the urogenital organs after a long history of heavy smoking. The cancers comprised a clear cell carcinoma of the right kidney, transitional cell carcinomas of the urinary bladder, left ureter and left renal pelvis, and adenocarcinoma of the prostate.
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7/15. Pulmonary complications of intravesical Bacille Calmette-Guerin immunotherapy.

    Lungs have rarely been reported to be affected by any side effects of BCG therapy. Interstitial pneumonitis, though, is known to occur under such circumstances, but its pathogenesis is still debated between an infectious and a hypersensitivity mechanism. We report here 3 cases of pulmonary complications of BCG therapy evaluated by bronchoalveolar lavage (BAL). Cellular data obtained from all 3 patients were characterized by a markedly increased alveolar lymphocytosis. The T4/T8 ratio was elevated compared with that in normal subjects and with the T4/T8 ratio of circulating lymphocytes. Furthermore, alveolar lymphocytes were highly sensitized to PPD, as evaluated by their proliferation and their production of interleukin 2 in the presence of PPD. Mycobacteria were not found in the 3 patients. We conclude that interstitial pneumonitis occurring during BCG therapy could be explained by a hypersensitivity phenomenon, leading to an intense immune and lymphocyte-mediated response within involved organs.
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8/15. water enema: a new ultrasound technique in defining pelvic anatomy.

    A new technique is described for delineating pelvic structures by using a distended bladder in combination with a water enema. The distended urinary bladder, which acts as a sonic window to the pelvis, fully defines only the portion of structures that abut against the surface. With fluid in both the bladder and rectosigmoid colon, and occasionally the cecum, a 'sandwich effect' can be obtained, resulting in a more complete definition of interposed structures. Questionable masses that might be feces in the bowel can be easily distinguished from significant pathology. This new technique has the potential for increasing accuracy of diagnosis of pelvic masses and delineating tumor extension of masses arising in such pelvic organs as the bladder, prostate, and uterus.
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9/15. melanosomes of pigmented basal cell epithelioma.

    Electron microscopic examination of a pigmented basal cell epithelioma of scrotal skin revealed many tumor cells and melanocytes which were laden with large packages of melanosomes. In tumor cells these packages were delimited by either single- or double-limiting membranes or were not membrane bound. The matrix of these large complexes was less electron dense and homogeneous than normal, containing electrontranslucent droplets besides melanosomes. No remnants of intracellular organelles such as nucleus, mitochondria or ribosomes could be found. The basal cell epithelioma cells in this case appear to have differentiated toward fetal basal cells and have developed the ability to phagocytize large packages of melanosomes.
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10/15. Radiographic evaluation of metastatic melanoma.

    Malignant melanoma can potentially involve any organ system in the body once it metastasizes beyond the regional lymph nodes. A survey of the radiographic and associated clinical manifestations of metastatic melanoma is presented. The findings from 74 autopsies of patients who died of metastatic melanoma are included.
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