Isolated eyeball metastasis of non-seminomatous germ cell testicular tumor

Introduction. Testicular tumors most frequently metastasize to regional lymph nodes. Non-seminomatous tumor metastasis of testicle (NSGCTT) to the eyeball is rare. Case report. We presented a 24-year old man, referred to the ophthalmologist due to acute pain and abrupt loss of sight in the left eye accompanied by its enlargement. Orbital and endocranial computerized tomography (CT) was carried out, indicating the tumor in the left eye. His previous medical history provided the information that the right testicle was painlessly enlarged for 8 months. Ultrasonography showed a completely tumorously altered testis. Abdominal and chest CT failed to reveal any secondary deposits in visceral organs and lymph glands. Tumor markers (AFP - alpha-fetoproteins, beta hCG - human choronic gonadotropin beta) were elevated. Right radical orchiactomy was performed (showed NSGCTT), followed by polychemotherapy with cisplatinum 100 mg/m2, etoposide 120 mg/m2, bleomycin 15 mg/m2 (PEB ´ 4), resulting in normalization of tumor marker values and significant regression of the left eyeball. Next, the left eye enucleation and ocular prosthesis implantation was carried out. Pathohistological evaluation indicated fibrosis and necrosis only. In a 5-year follow-up period, the patient was free of recurrence. Conclusion. Isolated hematogenous metastasis of the NSGCTT to the eye is rare. In our case, the left eye was the only metastatic localization. After chemotherapy and eye enucleation the patient was in a 4- year follow-up period free of the recurrence

Prognostic Significance of Systemic Inflammation Markers in Testicular and Penile Cancer: A Narrative Review of Current Literature

In contemporary clinical practice, biomarkers are indispensable in the assessment and management of oncological patients. Although established serum tumor markers (beta human chorionic gonadotropin (bHCG), alpha fetoprotein (AFP), and lactate dehydrogenase (LDH)) have an indisputably important role in the management of patients with testicular cancer (TC), the application of these tumor markers may be accompanied with certain limitations, implying the need for additional biomarkers. Contrary to TC, there is a lack of established serological biomarkers for penile cancer (PC) and the management of this urological malignancy is based on multiple clinicopathological parameters. Therefore, the identification and rigorous analytical and clinical validation of reliable biomarkers are considered pivotal for improving PC management. Inflammation may be associated with all stages of oncogenesis, from initial neoplastic transformation to angiogenesis, tissue invasion, and metastasis. Accordingly, an array of inflammation-related indices have gained increasing attention as emerging predictors of oncological outcomes. The clinical usefulness of systemic inflammation markers was reported in many urological and non-urological malignancies. The aim of this narrative review is to summarize current scientific data regarding the prognostic and predictive significance of systemic inflammation markers in TC and PC patients

Interplay between Comprehensive Inflammation Indices and Redox Biomarkers in Testicular Germ-Cell Tumors

Sustained and dysregulated inflammation, concurrent tumor-induced immune suppression, and oxidative stress are profoundly involved in cancer initiation, presentation, and perpetuation. Within this prospective study, we simultaneously analyzed the preoperative indices of systemic inflammatory response and the representative byproducts of oxidative DNA, protein, and lipid damage with the aim of evaluating their clinical relevance among patients diagnosed with testicular germ-cell tumors (GCT). In the analytical cohort (n = 88, median age 34 years), neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and C-reactive protein (CRP) were significantly altered in patients with a higher tumor stage (p < 0.05). Highly suggestive correlations were found between NLR, dNLR, and SII and modified nucleoside 8-OHdG. CRP and albumin-to-globulin ratio (AGR) significantly correlated with thiols group level and maximal tumor dimension (p < 0.05). Based on receiver operating characteristic (ROC) curve analyses, all the evaluated pre-orchiectomy inflammation markers demonstrated strong performance in predicting metastatic disease; optimal cut-off points were determined for each indicator. Although further large-scale studies are warranted, inflammatory and redox indices may both complement the established tumor markers and standard clinicopathological prognostic variables and contribute to enhanced personalized risk-assessment among testicular GCT patients

The Polymorphisms of Genes Encoding Catalytic Antioxidant Proteins Modulate the Susceptibility and Progression of Testicular Germ Cell Tumor

The simultaneous analysis of redox biomarkers and polymorphisms encoding for regulatory and catalytic antioxidant proteins was performed in order to evaluate their potential role in the development of testicular germ cell tumor (GCT), as well as the progression of the disease. NRF2 (rs6721961), GSTM3 (rs1332018), SOD2 (rs4880) and GPX3 (rs8177412) polymorphisms were assessed in 88 patients with testicular GCT (52 with seminoma) and 88 age-matched controls. The plasma levels of 8-hydroxy-2′-deoxyguanosine (8-OHdG), thiol groups and the plasma activity of glutathione peroxidase were measured. A significant association between variant GPX3*TC+CC genotype and risk of overall testicular GCT, as well as seminoma development, was found. Moreover, carriers of variant SOD2*TT genotype were at almost 3-fold increased risk of seminoma development. Interestingly, combined SOD2*TT/GPX3*TC+CC genotype conferred a 7-fold higher risk for testicular GCT development. Finally, variant GSTM3*AC+CC genotype was associated with a higher risk for the development of advanced diseased. The presence of assessed genetic variants was not associated with significantly higher levels of redox biomarkers in both testicular GCT patients, as well as in those diagnosed with seminoma. In conclusion, the polymorphic expression of certain antioxidant enzymes might affect susceptibility toward testicular GCT development, as well as the progression of the disease

The importance of conservative surgery in the treatment of localized renal cell carcinoma

U ovoj kohortnoj studiji ispitivali smo značaj konzervirajućih operacija u lečenju lokalizovanog karcinoma bubrežnog parenhima. U našem radu analizirane su: epidemiološke karakteristike, patoanatomske karakteristike tumora, patohistološke karakteristike, vrste operativnog lečenja, hirurške komplikacije i preživljavanje bolesnika sa lokalizovanim karcinomom bubrežnog parenhima. Ova studija sprovedena je na Urološkoj klinici Kliničkog centra Srbije u periodu 1996-2015.godine. Posebno su analizirani podaci koji su se odnosili na: godine starosti bolesnika u vreme hirurškog lečenja, pol bolesnika, komorbiditet, lokalizacija tumora, veličinu tumorske lezije, patohistološki tip. Za analizu podataka korišćene su metode deskriptivne i analitičke statistike, a za analizu preživljavanja primenjena je Kaplan-Majerova metoda. Od 204 bolesnika 120 (58,82%) bili su muškarci, a 84 (41,18%) su bile žene. Prosečna starosna dob bila je 58,808+-12,13 (24-79). Asimptomatska prezentacija tumora bila je kod 62,25% bolesnika. Prosečna veličina tumorske lezije iznosila je 38,64+-8,06 mm, a naveći broj bolesnika imao je tumor veličine 4cm. Kod 115 pacijenata urađena je konzervirajuća operacija zbog lokalizovanog karcinoma bubrežnog parenhima. Iz imperativnih indikacija poštedna operacija urađena je kod 32 bolesnika, dok je iz elektivnih razloga konzervirajuća operacija sprovedena kod 83 bolesnika. U našem istraživanju 79 bolesnika bilo je sa lokalizovanim karcinomom bubrega veličine do 4cm (T1a stadijuma) koji su operisani konzervirajućom operacijom u prisustvu normalnog kontralateralnog bubrega (elektivna indikacija). Kod 89 bolesnika sa lokalizovanim tumorom T1a stadijuma urađena je radikalna nefrektomija u prisustvu normalnog nalaza na suprotnom bubregu. Analizom naših rezultata zaključili smo da broj poštednih operacija iz godine u godinu raste, kao i da je sve veći broj pacijenata koji je lečen konzervirajućom procedurom iz elektivnih indikacija zbog lokalizovanog karcinoma bubrežnog parenhima. Iz analize petogodišnjeg preživljavanja Kaplan-Majerovom metodom pokazano je da nema razlike u preživljavanju između pacijenata kojima je urađena poštedna operacija bubrega i radikalna nefrektomija zbog tumora bubrega T1a stadijuma.In this cohort study we examined the importance of conservative surgery in the treatment of localised renal parenchyma carcinoma. In the course of study we analysed epidemiological features, pathoanatomic features of the tumour, pathohistological features, types of operative treatment, surgical complications and survival rate of the patients with localised renal parenchyma carcinoma. The study was conducted at the Urology Clinic of the Clinical Centre of Serbia in the period between 1996 and 2015. Data referring to patients’ age at the time of the surgical treatment, gender, comorbidity, tumour localisation, the size of tumour lesion and pathohistological type was analysed separately. Methods of descriptive and analytical statistics were used to analyse the data, and the Kaplan-Majer method was applied to analyse the survival rate. Out of 204 patients, 120 (58.82%) were male, and 84 (41.18%) were women. The average age of the patients was 58,808 +-12.13 (24-79). With 62.25% of the patients tumours presented asymptomatically. The average size of tumour lesion was 38.64+- 8.06mm, and the largest number of patients had 4cm tumours. 115 patients underwent conservative surgery because of the localised renal parenchyma carcinoma. Conservative surgery due to imperative indications was performed on 32 patients, whereas 83 patients underwent conservative surgery due to elective reasons. In our study, 79 patients had localised renal carcinomas up to 4cm in size (T1a stage), which were removed by conservative surgery in the presence of a normal contralateral kidney (elective indication). 89 patients with localised T1a stage tumours underwent a radical nephrectomy in the presence of normal contralateral kidney findings. After analysing our results, we concluded that the number of conservative surgeries has been growing over the years, and that there was an increasing number of patients treated for the localised renal parenchyma carcinoma by conservative procedures due to elective indications. The analysis of five-year survival rate has shown that there is no difference in survival rates between the patients who had conservative renal surgery and those who had radical nephrectomy due to T1a stage renal tumour

The importance of conservative surgery in the treatment of localized renal cell carcinoma

U ovoj kohortnoj studiji ispitivali smo značaj konzervirajućih operacija u lečenju lokalizovanog karcinoma bubrežnog parenhima. U našem radu analizirane su: epidemiološke karakteristike, patoanatomske karakteristike tumora, patohistološke karakteristike, vrste operativnog lečenja, hirurške komplikacije i preživljavanje bolesnika sa lokalizovanim karcinomom bubrežnog parenhima. Ova studija sprovedena je na Urološkoj klinici Kliničkog centra Srbije u periodu 1996-2015.godine. Posebno su analizirani podaci koji su se odnosili na: godine starosti bolesnika u vreme hirurškog lečenja, pol bolesnika, komorbiditet, lokalizacija tumora, veličinu tumorske lezije, patohistološki tip. Za analizu podataka korišćene su metode deskriptivne i analitičke statistike, a za analizu preživljavanja primenjena je Kaplan-Majerova metoda. Od 204 bolesnika 120 (58,82%) bili su muškarci, a 84 (41,18%) su bile žene. Prosečna starosna dob bila je 58,808+-12,13 (24-79). Asimptomatska prezentacija tumora bila je kod 62,25% bolesnika. Prosečna veličina tumorske lezije iznosila je 38,64+-8,06 mm, a naveći broj bolesnika imao je tumor veličine 4cm. Kod 115 pacijenata urađena je konzervirajuća operacija zbog lokalizovanog karcinoma bubrežnog parenhima. Iz imperativnih indikacija poštedna operacija urađena je kod 32 bolesnika, dok je iz elektivnih razloga konzervirajuća operacija sprovedena kod 83 bolesnika. U našem istraživanju 79 bolesnika bilo je sa lokalizovanim karcinomom bubrega veličine do 4cm (T1a stadijuma) koji su operisani konzervirajućom operacijom u prisustvu normalnog kontralateralnog bubrega (elektivna indikacija). Kod 89 bolesnika sa lokalizovanim tumorom T1a stadijuma urađena je radikalna nefrektomija u prisustvu normalnog nalaza na suprotnom bubregu. Analizom naših rezultata zaključili smo da broj poštednih operacija iz godine u godinu raste, kao i da je sve veći broj pacijenata koji je lečen konzervirajućom procedurom iz elektivnih indikacija zbog lokalizovanog karcinoma bubrežnog parenhima. Iz analize petogodišnjeg preživljavanja Kaplan-Majerovom metodom pokazano je da nema razlike u preživljavanju između pacijenata kojima je urađena poštedna operacija bubrega i radikalna nefrektomija zbog tumora bubrega T1a stadijuma.In this cohort study we examined the importance of conservative surgery in the treatment of localised renal parenchyma carcinoma. In the course of study we analysed epidemiological features, pathoanatomic features of the tumour, pathohistological features, types of operative treatment, surgical complications and survival rate of the patients with localised renal parenchyma carcinoma. The study was conducted at the Urology Clinic of the Clinical Centre of Serbia in the period between 1996 and 2015. Data referring to patients’ age at the time of the surgical treatment, gender, comorbidity, tumour localisation, the size of tumour lesion and pathohistological type was analysed separately. Methods of descriptive and analytical statistics were used to analyse the data, and the Kaplan-Majer method was applied to analyse the survival rate. Out of 204 patients, 120 (58.82%) were male, and 84 (41.18%) were women. The average age of the patients was 58,808 +-12.13 (24-79). With 62.25% of the patients tumours presented asymptomatically. The average size of tumour lesion was 38.64+- 8.06mm, and the largest number of patients had 4cm tumours. 115 patients underwent conservative surgery because of the localised renal parenchyma carcinoma. Conservative surgery due to imperative indications was performed on 32 patients, whereas 83 patients underwent conservative surgery due to elective reasons. In our study, 79 patients had localised renal carcinomas up to 4cm in size (T1a stage), which were removed by conservative surgery in the presence of a normal contralateral kidney (elective indication). 89 patients with localised T1a stage tumours underwent a radical nephrectomy in the presence of normal contralateral kidney findings. After analysing our results, we concluded that the number of conservative surgeries has been growing over the years, and that there was an increasing number of patients treated for the localised renal parenchyma carcinoma by conservative procedures due to elective indications. The analysis of five-year survival rate has shown that there is no difference in survival rates between the patients who had conservative renal surgery and those who had radical nephrectomy due to T1a stage renal tumour

The importance of conservative surgery in the treatment of localized renal cell carcinoma

U ovoj kohortnoj studiji ispitivali smo značaj konzervirajućih operacija u lečenju lokalizovanog karcinoma bubrežnog parenhima. U našem radu analizirane su: epidemiološke karakteristike, patoanatomske karakteristike tumora, patohistološke karakteristike, vrste operativnog lečenja, hirurške komplikacije i preživljavanje bolesnika sa lokalizovanim karcinomom bubrežnog parenhima. Ova studija sprovedena je na Urološkoj klinici Kliničkog centra Srbije u periodu 1996-2015.godine. Posebno su analizirani podaci koji su se odnosili na: godine starosti bolesnika u vreme hirurškog lečenja, pol bolesnika, komorbiditet, lokalizacija tumora, veličinu tumorske lezije, patohistološki tip. Za analizu podataka korišćene su metode deskriptivne i analitičke statistike, a za analizu preživljavanja primenjena je Kaplan-Majerova metoda. Od 204 bolesnika 120 (58,82%) bili su muškarci, a 84 (41,18%) su bile žene. Prosečna starosna dob bila je 58,808+-12,13 (24-79). Asimptomatska prezentacija tumora bila je kod 62,25% bolesnika. Prosečna veličina tumorske lezije iznosila je 38,64+-8,06 mm, a naveći broj bolesnika imao je tumor veličine 4cm. Kod 115 pacijenata urađena je konzervirajuća operacija zbog lokalizovanog karcinoma bubrežnog parenhima. Iz imperativnih indikacija poštedna operacija urađena je kod 32 bolesnika, dok je iz elektivnih razloga konzervirajuća operacija sprovedena kod 83 bolesnika. U našem istraživanju 79 bolesnika bilo je sa lokalizovanim karcinomom bubrega veličine do 4cm (T1a stadijuma) koji su operisani konzervirajućom operacijom u prisustvu normalnog kontralateralnog bubrega (elektivna indikacija). Kod 89 bolesnika sa lokalizovanim tumorom T1a stadijuma urađena je radikalna nefrektomija u prisustvu normalnog nalaza na suprotnom bubregu. Analizom naših rezultata zaključili smo da broj poštednih operacija iz godine u godinu raste, kao i da je sve veći broj pacijenata koji je lečen konzervirajućom procedurom iz elektivnih indikacija zbog lokalizovanog karcinoma bubrežnog parenhima. Iz analize petogodišnjeg preživljavanja Kaplan-Majerovom metodom pokazano je da nema razlike u preživljavanju između pacijenata kojima je urađena poštedna operacija bubrega i radikalna nefrektomija zbog tumora bubrega T1a stadijuma.In this cohort study we examined the importance of conservative surgery in the treatment of localised renal parenchyma carcinoma. In the course of study we analysed epidemiological features, pathoanatomic features of the tumour, pathohistological features, types of operative treatment, surgical complications and survival rate of the patients with localised renal parenchyma carcinoma. The study was conducted at the Urology Clinic of the Clinical Centre of Serbia in the period between 1996 and 2015. Data referring to patients’ age at the time of the surgical treatment, gender, comorbidity, tumour localisation, the size of tumour lesion and pathohistological type was analysed separately. Methods of descriptive and analytical statistics were used to analyse the data, and the Kaplan-Majer method was applied to analyse the survival rate. Out of 204 patients, 120 (58.82%) were male, and 84 (41.18%) were women. The average age of the patients was 58,808 +-12.13 (24-79). With 62.25% of the patients tumours presented asymptomatically. The average size of tumour lesion was 38.64+- 8.06mm, and the largest number of patients had 4cm tumours. 115 patients underwent conservative surgery because of the localised renal parenchyma carcinoma. Conservative surgery due to imperative indications was performed on 32 patients, whereas 83 patients underwent conservative surgery due to elective reasons. In our study, 79 patients had localised renal carcinomas up to 4cm in size (T1a stage), which were removed by conservative surgery in the presence of a normal contralateral kidney (elective indication). 89 patients with localised T1a stage tumours underwent a radical nephrectomy in the presence of normal contralateral kidney findings. After analysing our results, we concluded that the number of conservative surgeries has been growing over the years, and that there was an increasing number of patients treated for the localised renal parenchyma carcinoma by conservative procedures due to elective indications. The analysis of five-year survival rate has shown that there is no difference in survival rates between the patients who had conservative renal surgery and those who had radical nephrectomy due to T1a stage renal tumour

Urinary stasis in a transplanted kidney: 20 years of experience of one transplant center

Introduction/Objective. Urinary stasis in a transplanted kidney occurs due to ureteral obstruction caused by intrinsic or extrinsic etiological factors. The aim of this study was to determine the prevalence, time of occurrence, and etiopathogenetic factors of urinary stasis and their distribution according to the type of kidney donor. And to analyze the success of different types of surgical and conservative treatment. Methods. The retrospective-prospective randomized study included 580 patients transplanted in the Transplant Center, Clinic of Urology, University Clinical Center of Serbia, for a period of 20 years. After diagnosing urinary stasis, minimally invasive or open surgical interventions were performed, while for one group of patients the definitive treatment was non-surgical with observation and active monitoring. The main control parameters during non-surgical treatment were the diameter of pyelon, serum creatinine values, and urine culture findings. Results. Urinary stasis was found in 15% of transplanted patients. The largest number of transplanted patients had early urinary stasis, within three months of transplantation (68%). The most common etiological factors of urinary stasis were intrinsic factors (66%), which were significantly more frequent in transplant patients from a living donor. Non-surgical treatment with observation and active monitoring was successfully performed in 22% of the patients. Conclusion. The largest number of transplanted patients with urinary stasis has been successfully treated surgically, most often with open surgery. Surgical correction is advised in cases of pronounced dilatation of the canalicular system with a tendency to increase, in progressive decrease in renal function, and recurrent complicated urinary infections refractory to antibiotic therapy