An 82-year-old Caucasian man with a ductal prostate adenocarcinoma with unusual cystoscopic appearance: a case report

<p>Abstract</p> <p>Introduction</p> <p>Ductal adenocarcinoma is a rare variety of the common acinar adenocarcinoma. It usually presents with refractory symptoms, and during cystoscopy, it is seen as an exophytic lesion at the area of the verumontanum.</p> <p>Case presentation</p> <p>An 82-year-old Caucasian man was diagnosed with ductal adenocarcinoma of the prostate after undergoing transurethral resection of the prostate for urinary retention. Immunohistochemistry confirmed the nature of the tumor. The patient was treated with triptorelin, 3.75 mg once/month, and bicalutamide, 50 mg 1 × 1. The serum prostate-specific antigen at three, six and 12 months after transurethral resection of the prostate was 0.1 ng/ml. The patient remains asymptomatic, and he entered a six-month follow-up protocol.</p> <p>Conclusion</p> <p>Ductal adenocarcinoma often involves the central ducts of the gland and may present as an exophytic papillary lesion in the prostatic urethra. This is why it usually presents with refractory symptoms. The outcome for men with prostatic ductal adenocarcinoma is, in most studies, worse than the outcome for men with prostatic acinar adenocarcinoma. Aggressive management is indicated, even with low-volume metastatic disease.</p

Metastasis to Sartorius Muscle from a Muscle Invasive Bladder Cancer

Bladder cancer constitutes the ninth most common cancer worldwide and approximately only 30% of cases are muscle invasive at initial diagnosis. Regional lymph nodes, bones, lung, and liver are the most common metastases from bladder cancer and generally from genitourinary malignancies. Muscles constitute a rare site of metastases from distant primary lesions even though they represent 50% of total body mass and receive a large blood flow. Skeletal muscles from urothelial carcinoma are very rare and up to date only few cases have been reported in the literature. We present a rare case of 51-year-old patient with metastases to sartorius muscle 8 months after the radical cystectomy performed for a muscle invasive bladder cancer

Proteomics analysis of bladder cancer invasion: targeting EIF3D for therapeutic intervention

Patients with advanced bladder cancer have poor outcomes, indicating a need for more efficient therapeutic approaches. This study characterizes proteomic changes underlying bladder cancer invasion aiming for the better understanding of disease pathophysiology and identification of drug targets. High resolution liquid chromatography coupled to tandem mass spectrometry analysis of tissue specimens from patients with non-muscle invasive (NMIBC, stage pTa) and muscle invasive bladder cancer (MIBC, stages pT2+) was conducted. Comparative analysis identified 144 differentially expressed proteins between analyzed groups. These included proteins previously associated with bladder cancer and also additional novel such as PGRMC1, FUCA1, BROX and PSMD12, which were further confirmed by immunohistochemistry. Pathway and interactome analysis predicted strong activation in muscle invasive bladder cancer of pathways associated with protein synthesis e.g. eIF2 and mTOR signaling. Knock-down of eukaryotic translation initiation factor 3 subunit D (EIF3D) (overexpressed in muscle invasive disease) in metastatic T24M bladder cancer cells inhibited cell proliferation, migration, and colony formation in vitro and decreased tumor growth in xenograft models. By contrast, knocking down GTP-binding protein Rheb (which is upstream of EIF3D) recapitulated the effects of EIF3D knockdown in vitro, but not in vivo. Collectively, this study represents a comprehensive analysis of NMIBC and MIBC providing a resource for future studies. The results highlight EIF3D as a potential therapeutic target

Conservative management of a bladder leiomyosarcoma in a 43-year-old patient

Leiomyosarcoma of the bladder is an aggressive and rare tumor, with less than 200 reported cases. The treatment of bladder leiomyosarcoma is controversial although in most cases an aggressive surgical therapy is preferred. Usually, a radical cystectomy is performed, as it is considered to have a better disease-specific survival rate. A 43-year-old man presented to our Urology Department with painless macroscopic hematuria. He was submitted to transurethral resection of the tumor. The transurethral resection was complete and revealed only this small single lesion and the rest of the bladder was normal with no other lesion or suspicious lesion. The final histology revealed leiomyosarcoma of the bladder. Due to his age and the aggressiveness of the tumor after a thorough and detailed discussion with the patient a conservative management with aggressive follow up was decided. The patient a year after the diagnosis is in perfect condition without sign of a recurrence or metastastes

Detection of novel prostate cancer tumor markers in the urine after prostatic massage in individuals with high risk of prostate cancer

Pca is the second most common cancer and the sixth cause of death in men.It has been observed a raise in the prevalence rates of Pca worldwide 154 combined with a small reduction in the mortality rates.This raise can be mainly attributed to the wide use of PSA in western countries, which can help in the diagnosis both of the localized and the latent Pca. Nevertheless, even though PSA is the best biomarker for the Pca, it constitutes a biomarker that is specific for the prostate and not specific for a certain disease of the organ, causing many times diagnostic dilemmas. Therefore Pca is in desperate need for novel biomarkers. Based on a previous proteomic study of the A University Urology Clinic of Athens, performed on prostate tissue and on a thorough literature search, we chose various proteins to study in the urine of the participants. 127 samlpes of urine were collected from patients of high risk for Pca, according either to the DRE, either to the raised PSA(PSA>4ng/ml),or even the abnormal PSA velocity(PSAV >0,75ng/ml/year).The urine samples were stored to -80°c and a Western-blot analysis followed detecting the possible novel biomarkers.All the patients were subsequently subjected to a prostate biopsy.Even though four proteins(Cofilin-1,Hsp 90β, Glutathione Peroxidase 3 και ZAG) were analyzed with the Western-blot,only secretory ZAG was finally detected. With a cut-off point of 1.13 for the entire population ZAG had sensitivity 78.6% maintaining at the same time a very good specificity equal to 60% for the diagnosis of Pca. In the subgroup with PSA 4-10ng/ml with the same cuto-off point of 1.13 and with sensitivity of 73.9% ZAG maintained again high specificity equal to 59.1%.This is very important because in this subgroup of patients many times dilemmas are raised concerning the prostate biopsy.ZAG had an important predictive ability as a solo biomarker both in the entire population of the study and in the subgroup of patients with PSA 4-10ng/ml.At the same time the addition of ZAG to PSA improved significantly the predictive ability of PSA.This is also very important because PSA is still the best biomarker in our disposal for the diagnosis of Pca and every biomarker that improves the performance of PSA, at the same time improves our ability for the early diagnosis of Pca.Ο PCa αποτελεί τον δεύτερο πιο συχνά διαγνωσμένο καρκίνο και την έκτη αιτία θανάτου από καρκίνο στους άντρες.Έχει παρατηρηθεί μεγάλη αύξηση στα ποσοστά επίπτωσης του Pca σε πολλές χώρες παγκοσμίως που έχει συνδυαστεί με μικρή ελάττωση στα ποσοστά θνησιμότητας.Το μεγαλύτερο ποσοστό αυτής της αύξησης μπορεί να αποδοθεί στην εκτεταμένη χρήση του PSA στις δυτικές χώρες, το οποίο μπορεί να εντοπίσει τόσο τους διηθητικούς καρκίνους, όσο και τους λανθάνοντες μη θανατηφόρους που χωρίς την χρήση του PSA θα έμεναν ασυμπτωματικοί και αδιάγνωστοι κατά την διάρκεια της ζωής του ασθενούς. Παρόλα αυτά το PSA αν και ο καλύτερος βιοδείκτης που υπάρχει για τον Pca, αποτελεί έναν δείκτη ειδικό για τον προστάτη αλλά όχι για κάποια νόσο του,δημιουργώντας πολλές φορές διαγνωστικά διλήμματα. Η αναζήτηση νέων βιοδεικτών για τον καρκίνο του προστάτη αποτελεί επιτακτική ανάγκη.Στηριζόμενοι σε προηγούμενη πρωτεομική μελέτη της Ά Πανεπιστημιακής Ουρολογικής ομάδας που έγινε σε προστατικό ιστό και με βάση τα βιβλιογραφικά δεδομένα επιλέχθηκαν ορισμένες πρωτεϊνες για να μελετηθούν στα ούρα των συμμετέχοντων. Συλλέχθηκαν 127 δείγματα ούρων ατόμων υψηλού κινδύνου για Pca με βάση είτε την δακτυλική, είτε το αυξημένο PSA (PSA>4ng/ml),είτε την μη φυσιολογική μεταβολή στο χρόνο του PSA(PSAV >0,75ng/ml).Εν συνεχεία τα 153 δείγματα αποθηκεύονταν στους -80°c μέχρι να αναλυθούν με την Western-blotγια την παρουσία των βιοδεικτών.Όλοι οι ασθενείς υποβλήθηκαν σε βιοψία προστάτη. Από τις πρωτείνες(Cofilin-1,Hsp 90β,Glutathione Peroxidase 3 καιZAG) που μελετήθηκαν μόνο η εκκρινόμενη ZAGανιχνεύθηκε.Με βέλτιστο σημείο το 1.13 για το σύνολο του πληθυσμού του δείγματος η ZAG εμφάνιζε ευαισθησία 78.6%,διατηρώντας παράλληλα πολύ καλή ειδικότητα 60% για την διάγνωση του Pca.Στον πληθυσμό με PSA 4-10ng/ml με το ίδιο βέλτιστο σημείο και με ευαισθησία 73.9% η ZAG διατηρούσε και πάλι υψηλή ειδικότητα ίση με 59.1%, γεγονός πολύ σημαντικό καθώς στον πληθυσμό αυτό είναι που δημιουργούνται σε πολλές περιπτώσεις διαγνωστικά διλήμματα όσον αφορά την βιοψία προστάτη.Η ZAG δηλαδή εμφάνισε σημαντική προβλεπτική ικανότητα για τον Pca ως αυτοτελής βιοδείκτης τόσο μάλιστα στον ολικό πληθυσμό,όσο και στον πληθυσμό με PSA 4-10ng/ml.Παράλληλα η προσθήκη της ZAG στο PSA, βελτίωσε σημαντικά την προβλεπτική αξία του PSA,γεγονός επίσης πολύ σημαντικό καθώς το PSA εξακολουθεί να αποτελεί τον βασικό βιοδείκτη για τον Pca και κάθε βιοδείκτης που βελτιώνει την απόδοση του βελτιώνει και την ικανότητα μας για πρώιμη διάγνωση του καρκίνου του προστάτ

Ureteral endometriosis: A systematic literature review

Introduction: Ureteral endometriosis is a rare disease affecting women of childbearing age which presents with nonspecific symptoms and it may result in severe morbidity. The aim of this study was to review evidence about incidence, pathogenesis, clinical presentation, diagnosis, and management of ureteral endometriosis. Materials and Methods: PubMed Central database was searched to identify studies reporting cases of ureteral endometriosis. “Ureter” or “Ureteral” and “Endometriosis” were used as key words. Database was searched for articles published since 1996, in English without restrictions regarding the study design. Results: From 420 studies obtained through database search, 104 articles were finally included in this review, including a total of 1384 patients with ureteral endometriosis. Data regarding age, location, pathological findings, and interventions were extracted. Mean patients' age was 38.6 years, whereas the therapeutic arsenal included hormonal, endoscopic, and/or surgical treatment. Conclusions: Ureteral endometriosis represents a diagnostic and therapeutic challenge for the clinicians and high clinical suspicion is needed to identify it

B-lymphocytic infiltration of the prostate to a patient with chronic lymphocytic leukemia. A case report

Involvement of the prostate gland, as an early extra-nodal manifestation of a hematologic disease, or as a secondary infiltration is rare. Even rarer is the acute urinary retention due to infiltration by lymphocytes and simultaneously enlarged prostate. We present a case of a 61 years old male patient with a history of chronic lymphocytic leukemia, who was under oncological follow-up with no active treatment and had typical lower urinary tract symptoms due to benign prostatic hyperplasia and was receiving 5-alpha reductase inhibitor. After an acute urinary retention episode which was managed with a suprapubic catheter due to urethral catheter insertion failure, the patient was submitted to a transurethral prostatectomy. Histological examination revealed lymphocytic infiltration of the prostatic parenchyma by mostly small B cells. B-lymphocytic infiltration of the prostate gland, causes symptoms similar to benign prostatic hyperplasia. Acute urinary retention due to B-lymphocytic infiltration of the prostate is rare and the diagnosis is always histological and an oncological re-evaluation is necessary. The prognosis of these patients is related to the generalized disease rather than to the prostatic involvement

Idiopathic spontaneous perforation of the upper urinary tract. A presentation of 4 cases

Spontaneous perforation of the collecting system constitutes a rare entity masked by the presentation of a typical renal colic. However, it should not be forgotten when managing patients with colic, since missed diagnoses may carry significant morbidity. We herein present a series of spontaneous perforation of the collecting system without an apparent obstruction site evident in helical CT urography. Four consecutive patients who presented with typical renal colic were initially subjected to KUB and renal ultrasound imaging and were ultimately diagnosed with perforation of the collecting system via contrast enhanced- helical CT urography. Despite thorough evaluation, the cause responsible obstructive was not discovered and an exclusion diagnosis of idiopathic collecting system perforation was assigned to all patients. Due to the rarity of a spontaneous perforation traditional retrograde urography was performed in an effort to identify the possible cause but was also unrevealing. All patients were successfully treated with endourological means. Perforation of the collecting system without an evident obstructive cause is a rare entity with obscure etiology. A reasonable but yet unconfirmed speculation is that of a transient obstruction capable of a significant increase of intraluminal pressures