Advanced chondrosarcoma of the pelvis: a rare case of urinary obstruction

Chondrosarcoma is the second most common malignant tumor of the bone with an incidence of 1 in 200.000 per year. Axial skeleton is frequently involved showing poorer oncological outcomes than appendicular one: human pelvis is a site predilection. It is rarely associated to urinary obstruction but according to its localization, it can be frequently linked to compression of pelvic organs as bladder, prostate or bowel. We describe the case of a 52 years old caucasian male with history of advanced pelvic chondrosarcoma and severe hydronephrosis due to total bladder dislocation

Recommendations for a safe restart of elective aerosol-generating oral surgery procedures following the COVID-19 pandemic outbreak: An Italian multicenter study

Among healthcare workers, oral and maxillofacial surgeons are some of the most exposed to coronavirus disease (COVID-19). The aim of this retrospective study was to develop suggestions for continuing the work of oral and maxillofacial surgeons using a safe protocol for elective and urgent aerosol-generating procedures that could prevent the onset of new clusters. Based on the results obtained and a guidelines review of those Asian countries that had promptly managed the current pandemic, the following safety protocol was developed

Schistosomiasis infection mimicking a bladder cancer

Schistosomiasis is an acute and chronic disease caused by parasitic worms: it’s trasmitted by contact with water contaminated with parasites. Farmers, fishermen and people using unclean water, especially in endemic areas, can be easily infected. Urogenital, intestinal and hepatic localization are common. Furthermore, it’s estimated that at least 92% of patient requiring treatment for schistosomiasis live in Africa. It’s a very uncommon disease in Italy, but immigration, especially from North Africa, is changing its prevalence in our country. We describe a case report of a schistosomiasis infection mimicking a bladder cancer in a young black male coming from Africa

Purple urine bag syndrome: an uncommon hue

Purple urine bag syndrome (PUBS) is an uncommon clinical condition in Urology frequently linked to catheter associated infections2. It is characterized by a bright purple discoloration of the urine usually affecting patient with limited mobility, long-term catheter and multiple comorbidities. Although considered as a benign phenomenon, it is often associated with increasing anxiety in patient, families and clinicians due to the uncommon color of the urine which is caused by specific bacteria. There are debates regarding how aggressively to treat this condition but no official guidelines are actually available: reassurance of the patient, early antibiotic regimen and changing of chateter are suggested. We report the case of a palliative patient presenting with this rare condition

Priapism tamsulosin-induced in chronic renal failure: a case report

Introduction and purposes: Ischaemic priapism following adrenergic alpha-antagonist is a rare emergency but some cases have been reported in literature. While opportunely describeing a case report of priapism following tamsulosin ingestion which presented to us, we reviewed the literature using PubMed library and selected all the articles about the casual relationship between those two entities

Ischaemic priapism tamsulosin-induced in chronic renal failure: may this represent a risk factor?

Introduction: Ischaemic priapism following adrenergic alpha-antagonist is a rare emergency but some cases have been reported in literature. While opportunely describeing a case report of priapism following tamsulosin ingestion which presented to us, we reviewed the literature using PubMed library and selected all the articles about the casual relationship between those two entities: furthermore we looked for any other cases where priapism a-blockers-induced and chronic renal failure were both present in order to evaluate if this last condition may represent a risk factor. Patient and Methods: A 52 years old caucasian male with a clinical history of transplanted kidney presented to us for lower urinary tract symptoms related to a BPH condition. His prostate was firm and enlarged on digito-rectal examination. PSA and urine analysis were normal while blood examination revealed a chronic renal failure (creatinine 2,0 mg/dl). Empirical treatment with tamsulosin was initiated. Two days after the first dose of drug he developed a painfull persistent erection according to priapism diagnosis. After performing a distal shunt of the corpora and intracavernosal injection of etilephrine, full penile detumescence was obtained. Discussion: The proposed mechanism responsible for priapism following A1-antagonist is an alpha adrenergic blockade which directly inhibits the sympathetic impulse of detumescence expecially if a higher dose has been taken or its concentration is increased by metabolism inhibition. Although more common in non uroselective agents, few cases related to tamsulosin have been also described. In a systematic review of the literature 14 articles about priapism following a-blockers were found but to our knowledge this is the first case related to chronic renal function condition.. Conclusions: Adrenergic a-blockers are safe and effective drugs but, although rare, association with priapism is documented. Patient should be informed of the risk especially whenever affected by renal failure in order to not to delay medical care and earlier treat this urological emergenc

Non-urothelial bladder neoplasms: small-cell neuroendocrine cancer

BACKGROUND: Neuroendocrine tumors (NET) are uncommon neoplasms. Small cell carcinoma of the bladder (SCCB) is a rare, poorly differentiated neuroendocrine tumor. It takes origin from cells of nervous and endocrine systems whitin the bladder. Data in literature are limited and still remains under discussion the best therapeutic approach. Treatment may be multimodal. Prognosis remains poor. Here we report the case of old male affected by SCCB. While opportunely describing it, we also reviewed the literature. CASE REPORT: A 85 years old male presented to us for asymtomatic gross hematuria recently occurred. Bladder ultrasound (US) revealed a 4 cm mass on left wall highly suspicious for neoplasm. Total body contrast-enhanced CT confirmed the lesion; no signs of local infiltration, hydronephrosis or visceral-lyph nodes secundarisms were described. A trans urethral resection of the bladder (TURB) was offered. RESULTS: Pathology report revealed a high-grade T1G3 urothelial carcinoma (30% of specimen) associated to small-cell neuroendocrine variant (70% of specimen): microscopic muscle involvement was excuded. In order to better characterize the neuroendocrine differentiation, immunohistochemistry was mandatory: cytokeratin AE1-3, synaptophysin and Ki-67 were used as molecular markers (Fig. 1). Urothelial histotype resulted positive for cytokeratine but negative for synaptophysin while the neuroendocrine variant was positive for both of them. Ki-67, a molecular marker adopted as expression of proliferation rate, was 90% totally suggesting an aggressive mixed bladder neoplasm. The patient was classed as a highest-risk. Radical cystectomy with extended lymp nodes dissection was offered. DISCUSSION AND CONCLUSIONS: Non-urothelial bladder cancers are uncommon neoplasms: they include neuroendocrine tumor (NET), squamous cell carcinoma (SCC), adenocarcinoma, micropapillary (MCP), plasmocitoid (PUC) and sarcoma. Two forms of bladder NET have been described in literature: small- and a large-cell. Small-cell carcinoma of the bladder (SCCB) is a very rare, poorly differentiated neuroendocrine tumor accounting for 0,5-1,0% of all bladder neoplasms3 and characterized by a highly aggressive course. Patients affected are considered at highest-risk of metastatic spreading and poor prognosis. Risk factors are not completely known. SCCB commonly arises from cells of the endocrine and nervous systems differently expressed whitin the human bladder. Neuroendocrine lesions are histologically graded according to markers of cellular proliferation (Ki-67 index) rather than cellular polymorphism2: whenever urothelial hystotipe coexists, the WHO 2004 grading system is used to classify the urothelial variant. On immunoistochemistry, SCCB is reactive for neuroendocrine markers such as synaptophysin, chromogranin and periodically for CK7 and CK20. TNM system is currently used to staging these neoplasms. Clinical presentation is variable depending from location, staging and visceral-lymph nodes involvement. Radical cistectomy represents the gold standard. A multimodal treatment may be also offered differently combining surgery with chemoterapic regimens. The prognosis remains poor