Villous Adenoma Arising in the Urethra of a Female with Bladder Augmentation History: A Case Report and Review of the Literature

Villous adenomas (VAs) in the female urethra are rare with only seven cases in the English literature to our knowledge. In patients with bladder augmentation cystoplasty, the neoplasia development risk increases and most of these develop in the neobladder or anastomosis line. Only two cases of VA developing from the native bladder mucosa have been reported. Physical examination of a 76-year-old female who had a history of augmentation cystoplasty revealed a caruncula-like structure protruding from the urethral meatus. The urinary USG showed that the lesion had no relation with the bladder. The lesion was excised. Microscopically, it consisted of villous structures covered with pseudostratified intestinal type epithelium. Low-grade dysplasia was present in the epithelium but high-grade dysplasia or in-situ/invasive carcinoma was not observed. Immunohistochemical study showed positivity for CK7, CK20, EMA, CEA and CDX2. The case was reported as VA of the urethra. We presented the first VA case arising in the urethra of a female patient with intestinal bladder augmentation. Excision is curative for pure VAs. Transformation to carcinoma or recurrence has not been reported. However, in one third of the cases, a malignant tumor may accompany the lesion. Therefore, all excision material should be examined carefully. Routine endoscopic follow-up should be performed in cases with bladder augmentation

Heterotopic ossification of the anterior abdominal wall

Heterotopic ossification (HO) is a bone formation in a tissue other than the skeletal system. It is more often seen as a complication of orthopedic surgery; however, it is a pathological condition that might be observed during the healing process of abdominal incisions in the midline. The aim of this study is to present a case of a 63-year-old male patient with the complaints of induration and pain on the region of his previous incision through which he had been operated for achalasia. HO is also discussed in the light of the current literature

Plateletcrit and Red Cell-Distribution Width are Independent Predictors of the Slow Coronary Flow Phenomenon

Background and purpose: Endothelial dysfunction may play a role in the pathogenesis of the slow coronary flow (SCF) phenomenon. A detailed examination of blood cellular components has not been performed for this condition. We investigated the relationship between SCF and whole blood cell counts. Method: Records of 17,315 patients who underwent coronary angiography between January 2006 and December 2012 were evaluated retrospectively. A total of 146 patients with SCF were compared with 148 patients with normal coronary arteries according to demographic data, complete blood count, and biochemical parameters. Results: The following parameters were significantly higher in SCF patients than in patients with normal coronary arteries: percentage of smokers (36.3% vs. 25%, p = 0.036), body mass index (26.69 +/- 2.84 vs. 26.07 +/- 3.15, p = 0.049), white blood cells (WBCs) (7.52 +/- 1.43 x 10(3) mm(-3) vs. 7.01 +/- 1.42 x 10(3) mm(-3), p = 0.002), red cell distribution width (RDW) (13.68 +/- 1.42% vs. 13.15 +/- 1.13%, p < 0.001), platelets (250.29 +/- 50.96 x 10(3) mm(-3) vs. 226.10 +/- 38.02 x 10(3) mm(-3), p < 0.001), plateletcrit (PCT) (0.214 +/- 0.40% vs. 0.184 +/- 0.29%, p < 0.001), mean platelet volume (8.63 +/- 1.10 fL vs. 8.22 +/- 0.83 fL, p < 0.001), platelet distribution width (PDW) (16.58 +/- 0.76% vs. 16.45 +/- 0.57%, p = 0.028), and neutrophils (4.44 +/- 1.25 x 10(3) mm(-3) vs. 4.12 +/- 1.24 x 10(3) mm(-3), p = 0.029). Positive PCT values [odds ratio (OR), 4.165; 95% confidence interval (CI), 2.493-6.959; p < 0.001) and RDW (OR, 1.304; 95% Cl, 1.034-1.645; p = 0.025) were independent predictors of SCF. Conclusion: Although within the normal range, the increased numbers of WBCs and neutrophils in patients with SCF suggest that SCF may be a subclinical inflammatory condition. Furthermore, increased RDW and PDW in SCF patients may cause microvascular blood flow resistance due to impaired cell deformability. The PCT provides reliable data regarding total platelet mass and may be a useful predictor of SCF. (C) 2013 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.WoSScopu