Persistent painless hemospermia due to metastatic melanoma of the right seminal vesicle

Background Metastatic melanoma of the seminal vesicles is a very rare clinical entity and has been reported only once until today in a patient suffering from concomitant HIV infection 12 years ago. Case presentation We report a case of persistent, painless hemospermia in a young Caucasian caused by metastatic malignant melanoma of the right seminal vesicle. The diagnosis was established by magnetic resonance imaging and transrectal ultrasound-guided biopsy. In the subsequent diagnostic workup the primary location of the tumor remained unknown but concomitant pulmonary, hepatic and supraclavicular lymph node metastases have been detected. Despite immediate chemotherapy initiation the patient finally succumbed to his progressive disease six months later. Conclusions Malignant melanoma should be considered as a rare differential diagnosis of hemospermia after common causes have been ruled out

Tumor thrombus of inferior vena cava in patients with renal cell carcinoma - clinical and oncological outcome of 50 patients after surgery

Background To evaluate oncological and clinical outcome in patients with renal cell carcinoma (RCC) and tumor thrombus involving inferior vena cava (IVC) treated with nephrectomy and thrombectomy. Methods We identified 50 patients with a median age of 65 years, who underwent radical surgical treatment for RCC and tumor thrombus of the IVC between 1997 and 2010. The charts were reviewed for pathological and surgical parameters, as well as complications and oncological outcome. Results The median follow-up was 26 months. In 21 patients (42%) distant metastases were already present at the time of surgery. All patients underwent radical nephrectomy, thrombectomy and lymph node dissection through a flank (15 patients/30%), thoracoabdominal (14 patients/28%) or midline abdominal approach (21 patients/42%), depending upon surgeon preference and upon the characteristics of tumor and associated thrombus. Extracorporal circulation with cardiopulmonary bypass (CPB) was performed in 10 patients (20%) with supradiaphragmal thrombus of IVC. Cancer-specific survival for the whole cohort at 5 years was 33.1%. Survival for the patients without distant metastasis at 5 years was 50.7%, whereas survival rate in the metastatic group at 5 years was 7.4%. Median survival of patients with metastatic disease was 16.4 months. On multivariate analysis lymph node invasion, distant metastasis and grading were independent prognostic factors. There was no statistically significant influence of level of the tumor thrombus on survival rate. Indeed, patients with supradiaphragmal tumor thrombus (n = 10) even had a better outcome (overall survival at 5 years of 58.33%) than the entire cohort. Conclusions An aggressive surgical approach is the most effective therapeutic option in patients with RCC and any level of tumor thrombus and offers a reasonable longterm survival. Due to good clinical and oncological outcome we prefer the use of CPB with extracorporal circulation in patients with supradiaphragmal tumor thrombus. Cytoreductive surgery appears to be beneficial for patients with metastatic disease, especially when consecutive therapy is performed. Although sample size of our study cohort is limited consistent with some other studies lymph node invasion, distant metastasis and grading seem to have prognostic value

Troubleshooting of failed continence mechanisms in the ileocecal pouch: Operative technique and long-term results of the intussuscepted ileal nipple valve

Objectives To provide a detailed step-by-step operative technique, and to report on long-term functional and metabolic outcomes in secondary continence mechanisms in the form of secondary intussuscepted ileal nipple valves in revisional surgery of ileocecal pouches. Methods From May 1997 to May 2015, 18 female and 10 male patients suffering from dysfunctional primary continence mechanisms of their ileocecal pouch underwent revisonal surgery to create a secondary ileal nipple valve at our tertiary referral center. The average follow-up period was 65.4 months. Results After surgery, 24 patients were continent by day and night, and four patients showed minor incontinence with the use of a safety pad. The average frequency of clean intermittent catheterization decreased both during the day and at night. The diameter of the catheters used for clean intermittent catheterization increased significantly. No patient showed stomal stenosis, change of stool habits or metabolic situation in the follow-up period. Furthermore, the creation of the secondary ileal nipple valves did not affect the capacity of the reservoir. In the long-term follow up, two patients required the construction of a third continence mechanism, making for an overall success rate of 92% in the study group. Conclusion To our knowledge, this is the first study of long-term results after the creation of secondary ileal nipple valves. We provide evidence that the creation of a secondary ileal nipple valve is a safe and reliable procedure for continence restoration in ileocecal pouches with excellent functional and metabolic long-term outcomes

Combination of expression levels of miR-21 and miR-126 is associated with cancer-specific survival in clear-cell renal cell carcinoma

BACKGROUND Renal cell carcinoma (RCC) is marked by high mortality rate. To date, no robust risk stratification by clinical or molecular prognosticators of cancer-specific survival (CSS) has been established for early stages. Transcriptional profiling of small non-coding RNA gene products (miRNAs) seems promising for prognostic stratification. The expression of miR-21 and miR-126 was analysed in a large cohort of RCC patients; a combined risk score (CRS)-model was constructed based on expression levels of both miRNAs. METHODS Expression of miR-21 and miR-126 was evaluated by qRT-PCR in tumour and adjacent non-neoplastic tissue in n = 139 clear cell RCC patients. Relation of miR-21 and miR-126 expression with various clinical parameters was assessed. Parameters were analysed by uni- and multivariate COX regression. A factor derived from the z-score resulting from the COX model was determined for both miRs separately and a combined risk score (CRS) was calculated multiplying the relative expression of miR-21 and miR-126 by this factor. The best fitting COX model was selected by relative goodness-of-fit with the Akaike information criterion (AIC). RESULTS RCC with and without miR-21 up- and miR-126 downregulation differed significantly in synchronous metastatic status and CSS. Upregulation of miR-21 and downregulation of miR-126 were independently prognostic. A combined risk score (CRS) based on the expression of both miRs showed high sensitivity and specificity in predicting CSS and prediction was independent from any other clinico-pathological parameter. Association of CRS with CSS was successfully validated in a testing cohort containing patients with high and low risk for progressive disease. CONCLUSIONS A combined expression level of miR-21 and miR-126 accurately predicted CSS in two independent RCC cohorts and seems feasible for clinical application in assessing prognosis

Physiopathological mechanism determination of rare coagulation abnormalities using in vitro experiments and innovative genetic approaches

Les déficits en facteurs de la coagulation sont des pathologies hémorragiques congénitales rares. Le développement récent des techniques de biologie moléculaire ont permis l'indentification de nombreuses anomalies génétiques dans les gènes codant les facteurs de coagulation. Cependant, la détermination de l'impact clinique réel de ces nouveaux variants est souvent un défi pour le biologiste moléculaire.La première partie de ce travail a consisté à l'étude par analyse chromosomique sur puce à ADN de grands réarrangements génomiques identifiés chez des patients hémophiles A ou B ayant parfois des phénotypes cliniques atypiques. Nous avons montré que certains gènes voisins des gènes F8 et F9 étaient associés, lorsqu'ils sont concernés par ces réarrangements de grande taille, à des déficits mentaux (SOX3) ou des pathologies cardiovasculaires (BRCC3).La seconde partie de cette étude a été centrée sur l'étude des variants de signification indéterminée localisés au niveau des sites d'épissage. Nous avons démontré par l'utilisation conjointe d'algorithmes informatiques et de tests in vitro de type minigène la pathogénicité de 21 variants identifiés chez des hémophiles A.La dernière partie de ce travail a consisté en la description de nouveaux mécanismes moléculaires responsables de pathologies hémorragiques. Nous avons identifié une délétion intronique chez 6,1% des hémophiles A mineurs de notre cohorte. Nous avons montré que cette anomalie était probablement responsable d'une dérégulation de l'hnRNP C ce qui entrainait l'insertion d'une séquence AluY dans les transcrits du gène F8. Enfin, nous avons décrit les mécanismes moléculaires responsables de la présence de concentrations très élevées de thrombomoduline soluble dans les plasmas de patients porteur de la mutation du gène THBD c.1611C>A. Ces travaux ont permis de détecter et de mieux appréhender certains mécanismes moléculaires responsables de pathologies rares hémorragiquesInherited coagulation disorders are caused by a large number of genetic abnormalities. However, the determination of the clinical impact for some of these genetic variations is challenging for the molecular biologist.In a first part, we characterized large genomic rearrangements in haemophilia patients using cytogentic microarray analysis. In a first study, we delineated six F9 complete deletions in order to investigate genotype/phenotype correlations. We identified SOX3 as a candidate gene for intellectual disability (ID) found Haemophilia B patients. In a second study, we described five complex Xq28 rearrangements in Haemophilia A (HA) patients. We showed that several F8 neighbouring genes are involved in these rearrangements and some of these genes are involved in other pathologies such as ID, physical abnormalities and cardiovascular disease. Such investigations would be particularly useful for genetic counseling in female carriers to assess the risk of transmitting haemophilia associated with other diseases.In a second, we developed a minigene assay to characterise putative splice site mutations in F8 and we showed that 21 out of the 26 variations studied are associated with splicing defect.In the third part, we described two original molecular mechanisms leading to coagulation disorders. In a first case, we reported a recurrent deep intronic deletion in mild HA. We gave some evidences that this deletion promoted AluY exonization in F8 transcrits. Due to its high prevalence (6.1%), this deletion must be investigated in all patients with mild HA in whom no mutation has been detected by standard genetic analysis. In the second study we investigated the mechanism responsible for bleeding tendency in patient carrying the THBD c.1611C>A and having high levels of soluble thrombomoduline (TM). We showed that a higher sensitivity of the mutated TM to the proteolysis by metalloproteases and a defect of TM synthesis seemed responsible for TM sheddin