Plasmacytoid urothelial carcinoma of the bladder: a case report

Plasmacytoid bladder cancer is a rare variant of transitional cell carcinoma. A 57-year-old man was referred to our institution for management of invasive transitional cell carcinoma diagnosed at a peripheral hospital. His complaints were of vague lower abdominal pain with associated urgency and frequency requiring oxybutynin. Metastatic workup was negative and was subsequently scheduled for a radical cystectomy. Routine colonoscopy 3 weeks prior to surgery was negative. Intraoperatively, he was found to have metastatic urothelial cancer involving the cecum and multiple metastatic deposits within the mesentery of the small intestines. He underwent a palliative cystectomy with ileal conduit formation. Final pathology revealed metastatic plasmacytoid variant of urothelial cancer. Histology and immunohistochemistry were compatible with plasmacytoid variant of urothelial cancer. Here we present our case of this rare variant of urothelial cancer with a review of its characteristics

Retroperitoneal lymph node dissection for residual masses after chemotherapy in nonseminomatous germ cell testicular tumor

<p>Abstract</p> <p>Background</p> <p>Retroperitoneal lymph node dissection has been advocated for the management of post-chemotherapy (PC-RPLND) residual masses of non-seminomatous germ cell tumors of the testis (NSGCT). There remains some debate as to the clinical benefit and associated morbidity. Our objective was to report our experience with PC-RPLND in NSGCT.</p> <p>Methods</p> <p>We have reviewed the clinical, pathologic and surgical parameters associated with PC-RPLND in a single institution. Between 1994 and 2008, three surgeons operated 73 patients with residual masses after cisplatin-based chemotherapy for a metastatic testicular cancer. Patients needed to have normal postchemotherapy serum tumor markers, no prior surgical attempts to resect retroperitoneal masses and resectable retroperitoneal tumor mass at surgery to be included in this analysis</p> <p>Results</p> <p>Mean age was 30.4 years old. Fifty-three percent had mixed germ cell tumors. The mean size of retroperitoneal metastasis was 6.3 and 4.0 cm, before and post-chemotherapy, respectively. In 56% of patients, the surgeon was able to perform a nerve sparing procedure. The overall complication rate was 27.4% and no patient died due to surgical complications. The pathologic review showed presence of fibrosis/necrosis, teratoma and viable tumor (non-teratoma) in 27 (37.0%), 30 (41.1%) and 16 (21.9%) patients, respectively. The subgroups presenting fibrosis and large tumors were more likely to have a surgical complication and had less nerve sparing procedures.</p> <p>Conclusion</p> <p>PC-RPLND is a relatively safe procedure. The presence of fibrosis and large residual masses are associated with surgical complications and non-nerve-sparing procedure.</p

[34] Robot-assisted partial nephrectomy: Initial experience from a single centre

Objective: To present Kuwait’s initial experience and outcomes of robot-assisted partial nephrectomy (RAPN) using the da Vinci® Si robot (Intuitive Surgical Inc., Sunnyvale, CA, USA), as advances in urology have focused on minimising the invasiveness of surgical procedures without compromising oncological outcomes. Methods: After Institutional Review Board approval, data were recorded for all patients who underwent RAPN at our centre. Complications were graded using the Clavien–Dindo system and defining major complications as Grade ⩾III. Results: Between February 2014 and June 2018, a single surgeon’s robotic experience at Sabah Alahmad Urology Center (SAUC) included a total of 136 cases (116 cases as the main console surgeon and 20 cases with an invited robotic proctor). Of these, 25 cases (18%) were RAPN (21 cases as the main console surgeon and four cases with an invited robotic proctor). The mean age of the RAPN patients was 51 years. The mean size of the renal masses was 3 cm. The mean renal nephrometry score was 7.45. The most complex tumour had a score of 9 a+h. Eight tumours were posteriorly located. All patients underwent either warm or zero ischaemia PN. There was one major complication (Clavien–Dindo Grade IIIa), where a patient developed fever and perinephric urinoma requiring percutaneous drainage under local anaesthesia. The median hospital stay was 2 days. The mean estimated blood loss was 318 mL. Pathology included 22 malignant renal cell carcinomas (RCCs) with negative surgical margins and three benign tumours. One patient had two tumours resected from the same kidney during the same procedure and showed papillary type II and clear cell RCC. No tumour recurrence occurred over a mean follow-up of 15 months. Conclusion: Our centre’s initial RAPN experience shows good patient and operative outcomes. A larger number of cases are required to allow a definite conclusion. Dedication of all members of the robotic team is crucial to ensure good patient outcomes

[32] Perceptions of robot-assisted surgery: Results of a survey of surgeons in Kuwait

Objective: To gain insight into local surgeons’ perceptions of robot-assisted surgery (RAS), as the use of RAS has rapidly increased amongst hospitals worldwide and the da Vinci® Si surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) was installed at Sabah Al-Ahmad Urology Center (SAUC) in February 2014 and at Kuwait’s Chest Disease Hospital in October 2017, with >200 robotic surgical procedures performed by robotic surgeons using these two systems, overall surgeons perceptions and acceptance of this new technology in Kuwait are largely unknown. Methods: We conducted a questionnaire-based survey distributed amongst surgeons of different subspecialties. The questionnaire had 28 questions related to the surgeon’s knowledge of RAS, it’s availability in Kuwait, and surgeons attitudes and concerns towards it. Results: There were 292 surveys, with 278 used for analysis (95.2% response rate). General surgeons, urologists, and gynaecologists constituted 54%, 23%, and 13%, respectively. The mean age of respondents was 36 years. There was a significant association between younger age groups and comfort using the technology (P< 0.05). In all, 250 surgeons (91%) had previously heard of RAS, and the majority (73%) agreed with its introduction into surgical practice mostly gynaecologists, urologists and general surgeons (P< 0.001) due to their belief of its enhanced precision and better visualisation. However, 50% of surgeons thought that laparoscopic surgery performs what RAS does. When surgeons were asked to rate factors according to their importance when choosing RAS they indicated faster recovery, lower complications, and patient demand were most important (P< 0.001) Conclusion: RAS seems to be an accepted modality amongst surgeons in Kuwait. However, surgeons remain concerned regarding the learning curve, device cost, and availability for use

Genetic variations in the transforming growth factor beta pathway as predictors of bladder cancer risk.

Bladder cancer is the fifth most common cancer in the United States, and identifying genetic markers that may predict susceptibility in high-risk population is always needed. The purpose of our study is to determine whether genetic variations in the transforming growth factor-beta (TGF-β) pathway are associated with bladder cancer risk. We identified 356 single-nucleotide polymorphisms (SNPs) in 37 key genes from this pathway and evaluated their association with cancer risk in 801 cases and 801 controls. Forty-one SNPs were significantly associated with cancer risk, and after adjusting for multiple comparisons, 9 remained significant (Q-value ≤0.1). Haplotype analysis further revealed three haplotypes within VEGFC and two haplotypes in EGFR were significantly associated with increased bladder cancer risk compared to the most common haplotype. Classification and regression tree analysis further revealed potential high-order gene-gene interactions, with VEGFC: rs3775194 being the initial split, which suggests that this variant is responsible for the most variation in risk. Individuals carrying the common genotype for VEGFC: rs3775194 and EGFR: rs7799627 and the variant genotype for VEGFR: rs4557213 had a 4.22-fold increase in risk, a much larger effect magnitude than that conferred by common genotype for VEGFR: rs4557213. Our study provides the first epidemiological evidence supporting a connection between TGF-β pathway variants and bladder cancer risk