A rare case of primary malignant small cell carcinoma combined with urothelial cell carcinoma in the ureter

BACKGROUND: Extrapulmonary small cell carcinomas have been reported in a variety of organs, and their incidence in the genitourinary tract is second only to that in the gastrointestinal tract. To date, however, only a few cases of small cell carcinoma of the ureter have been reported. Because the extreme rarity of this type of carcinoma, its clinical behaviour, diagnostic methods, and effective treatment modalities have not yet been determined. CASE PRESENTATION: A 59-year-old man presented with a 1-month history of painless gross haematuria. Urine cytopathology revealed a urothelial carcinoma and computed tomography revealed left hydronephroureterosis with a distal ureteral stone and a mildly enhanced fungating mass just below the stone-impacted site. The preoperative TNM stage was T2N0M0. The patient underwent simultaneous diagnostic ureterorenoscopy and left laparoscopic nephroureterectomy with bladder cuff resection. Gross examination showed a 3.5 × 3.0 × 0.8 cm white, partly yellow mass in the left distal ureter. Light microscopy showed a small cell carcinoma, overlaid on a urothelial carcinoma in situ, invading the ureter and external lateral resection margins. The small cell carcinoma was diffusely positive for neuron-specific enolase, and exhibited focal positivity for CD 56, synaptophysin, chromogranin and cytokeratin 20. The patient was treated with adjuvant chemotherapy, consisting of cisplatin and etoposide, and radiation therapy, and has been well, without evidence of tumour recurrence or metastasis in the 10 months after surgery. CONCLUSION: Small cell carcinoma of the ureter is rare. Although its clinical behaviour and diagnostic modalities have not been determined and it has yet to be diagnosed immunohistopathologically, multimodality treatment including surgery, chemotherapy and radiotherapy may improve patient survival

Erectile dysfunction and angiographic correlation between coronary artery stenosis and internal iliac-internal pudendal artery stenosis in patients with suspected coronary artery disease: a retrospective study

This study aimed to assess the angiographic correlation between coronary artery stenosis and internal iliac-internal pudendal artery (II-IPA) stenosis and evaluate its association with erectile dysfunction (ED). We reviewed the data of 91 patients who had undergone pelvic angiography (PA) to evaluate II-IPA stenosis and coronary angiography (CAG) due to suspected coronary artery disease. Erectile function (EF) was evaluated using the International Index of Erectile Function before CAG and PA. CAG was performed first, followed by PA of the bilateral II-IPA. Regardless of the location and number of stenosis sites, based on CAG, we categorized the patients into two groups. Patients with a maximum stenosis <50% and ≥50% on CAG were assigned to Group I and Group II, respectively. Then, the EF domain score and the diameter stenosis (DS) of II-IPA were evaluated and compared. Overall, 55 patients comprised Group I, while 36 patients comprised Group II. ED was present in 96.3% and 97.2% of the patients in Group I and II, respectively. There was no statistical difference between the groups in the severity of ED (p = 0.457). PA revealed that 14.5% and 36.1% of patients in Groups I and II had ≥50% stenosis of the II-IPA. The mean DS of II-IPA in Group II was greater than that in Group I (p = 0.017). There was a statistically significant correlation between the degree of coronary artery stenosis and the degree of II-IPA stenosis (r = 0.295, p = 0.005). This study revealed that coronary artery stenosis correlates with II-IPA stenosis. The presence and degree of coronary artery stenosis or II-IPA stenosis indicate the necessity for more active treatment in patients with ED

Preservation of Erectile Function by Statins in a Rat Model of Erectile Dysfunction Induced by Hypercholesterolemia

Background and objective To assess the effects of hypercholesterolemia (HC) on the quality of erections and to evaluate the effects of stain therapy in a rat model of erectile dysfunction (ED) induced by HC. Material and methods Sprague–Dawley rats were randomly divided into three groups (n=12 in each): control, HC, and HC with simvastatin treatment (HC+SS). The control was fed a normal chow diet, and the HC and HC+SS were fed a high-fat and high-cholesterol diet for 12 weeks. The HC+SS received simvastatin once daily via oral gavage for 12 weeks. Subsequently, the intraperitoneal glucose tolerance test (IPGTT), intra-cavernous pressure and mean arterial pressure, lipid profiles, expression of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS), oxidative stress (8-hydroxy-2-deoxygua-nosine, 8-OHdG level), serum testosterone levels, and the ratio of collagen fibers (CF) and smooth muscle (SM) were evaluated in the serum and corpora tissue. Results IPGTT was not different among all groups. The HC showed markedly lower erectile parameters than the control. In contrast, the HC+SS showed preserved erectile function, improved lipid profiles, increased eNOS and nNOS, decreased oxidative stress, and minimized change in SM/CF ratio. Conclusions Our results suggest that oxidative stress damage by HC may cause ED and that statin therapy may have beneficial effects on preserving erectile function by improving lipid profiles and minimizing dam-age caused by oxidative stress

Correlation between internal pudendal artery stenosis and erectile dysfunction in patients with suspected coronary artery disease.

BackgroundStenoses of internal pudendal arteries (IPAs) appear to be related to erectile dysfunction (ED). Nevertheless, the correlation between the severity of ED and stenosis of the IPAs is not well established.ObjectivesTo evaluate angiographic findings of IPAs in patients with suspected coronary artery disease (CAD) and to assess the correlation between the severity of ED and IPA stenosis.Materials and methodsNinety-one patients who were scheduled for cardiac angiogram (CAG) because of suspected CAD participated. ED was assessed using the International Index of Erectile Function (IIEF) questionnaire. Erectile function (EF) domain scoring was used to assess the severity of ED: severe (EF score = 1-10); moderate (11-16); mild-moderate (17-21); mild (22-25); and no ED (26-30). Angiography was performed in bilateral common, internal iliac, and IPAs and the location and extent of stenoses were measured. We divided patients according to those with maximum stenosis of less than 50% (Group I) and those with more than 50% (Group II), regardless of direction.ResultsWe diagnosed 88 patients (88/91, 96.70%) with ED. There was no correlation between increasing age and severity of ED (r = - 0.063, p = 0.555). There were 72 patients in Group I and 19 in Group II. In Group I, 62 patients were diagnosed with ED even though there was no stenosis. There was no significant correlation between the severity of ED and the extent of stenosis in IPAs (r = -0.118, p = 0.265).ConclusionsThere was no significant correlation between the severity of ED and the extent of stenosis of IPAs. We believe that this is because the progression of ED is induced by endothelial cell dysfunction, not by mechanical obstruction leading to blood flow reduction