Primary osteosarcoma of bladder diverticulum mimicking intradiverticular calculus: a case report

There is a well-documented relationship between urinary bladder diverticula and intradiverticular neoplasms. The great majorities of these tumors are urothelial carcinomas, but may also be of glandular or squamous type. Sarcomas occurring within bladder diverticula are exceptionally rare and highly malignant lesions, with only 20 well documented cases published in the literature to date (including carcinosarcomas). We report a case of osteosarcoma of the bladder diverticulum in a 68-year old man, which clinically mimicked intradiverticular calculus. To our knowledge, this is the second case described in the literature to date, and the first in English literature

Otkrivanje karcinoma prostate u ponovljenim biopsijama prostate u bolesnika s prethodno negativnim nalazom

The purpose of this report is to show our own results of repeat transrectal ultrasound guided biopsies, with special reference to the prevalence of newly diagnosed carcinoma in the transition zone of the prostate. Transrectal ultrasound guided repeat biopsies (six cores laterally plus two cores from transition zones) were performed in 64 patients. Indications for repeat biopsy were persistently elevated prostate specific antigen (PSA) levels of 4.0 ng/ml or more, premalignant lesions noted in previous biopsy result (PIN, prostatic intraepithelial neoplasia; ASAP, atypical small acinar proliferation; and AAH, atypical adenomatous hyperplasia), PSA velocity of 0.75 ng/ml per year or more, PSA density of 0.15 ng/ml/ccm or more, and free/total P.A ratio less than 18%. Twenty-one (32%) patients had positive biopsies for prostate cancer, and the rest of 43 (68%) patients were diagnosed as having benign prostate hyperplasia, inflammation, normal prostate tissue, or suspect lesions. When stratified according to anatomic location of positive cores, 19.1% of patients had isolated transition zone tumors on repeat biopsy, and 28.6% had both transition and peripheral zone tumors. A total of 23 (35.93%) patients with premalignant lesions on initial biopsy were also included. Of these, repeat biopsy pathologic specimens indicated malignancy in nine (39.1%) patients. There is a significant false-negative rate for initial transrectal ultrasound guided biopsy. Therefore, repeat biopsy is recommended in all patients who meet the criteria for transrectal ultrasound guided biopsy and in those in whom initial biopsy is negative. Also, classic sextant biopsy laterally plus two cores from each transition zone of the prostate is recommended to reduce the false-negative rate in repeat biopsies due to the high detection rate of cancer in the transition zone of the prostate. Recent literature on the topic is reviewed and discussed.U članku se opisuju vlastiti rezultati kod prve ponavljane, transrektalnim ultrazvukom vođene biopsije prostate, uz poseban osvrt na učestalost novodijagnosticiranog karcinoma u prijelaznoj zoni. Ponavljane transrektalnim ultrazvukom vođene biopsije prostate (6 cilindara lateralno i 2 iz prijelazne zone) učinjene su u 64 bolesnika. Indikacije za ponavljanu biopsiju prostate bile su tvrdokorno povišene vrijednosti za prostatu specifičnog antigena (PSA), brzina porasta PSA kroz godinu dana, gustoća PSA veća od 15 ng/ml/ccm i omjer slobodno i ukupnog PSA manji od 18%, prethodna biopsija s predmalignim lezijama, te sumnjivi digitorektalni nalaz. U 21 (32%) bolesnika na ponavljanoj biopsiji otkriven je karcinom prostate, a u ostalih 43 (68%) nalaz je bio upala, benigna prostatična hipertrofija ili predmaligna lezija. U 19,1% bolesnika na ponavljanoj biopsiji tumor je zabilježen u prijelaznoj zoni, a u 28,6% tumor je nađen u prijelaznoj i perifernoj zoni. U 23 (35,93%) bolesnika s predmalignim lezijama na inicijalnoj biopsiji učinjena je ponavljana biopsija, te je karcinom prostate otkriven u 9 (39,1%) bolesnika. Na inicijalnoj biopsiji prostate značajan je broj lažno negativnih nalaza. Ponavljana transrektalnim ultrazvukom vođena biopsija preporuča se u svih bolesnika koji zadovoljavaju kriterije za biopsiju prostate, te u kojih je inicijalna biopsija negativna. Također se preporuča učiniti klasičnu sekstant biopsiju lateralnije uz dva dodatna cilindra iz prijelazne zone prostate upravo zbog visoke razine otkrivanja karcinoma u prijelaznoj zoni. Prikazan je i kritički pregled novije literature o ovoj problematici

Otkrivanje karcinoma prostate u ponovljenim biopsijama prostate u bolesnika s prethodno negativnim nalazom

The purpose of this report is to show our own results of repeat transrectal ultrasound guided biopsies, with special reference to the prevalence of newly diagnosed carcinoma in the transition zone of the prostate. Transrectal ultrasound guided repeat biopsies (six cores laterally plus two cores from transition zones) were performed in 64 patients. Indications for repeat biopsy were persistently elevated prostate specific antigen (PSA) levels of 4.0 ng/ml or more, premalignant lesions noted in previous biopsy result (PIN, prostatic intraepithelial neoplasia; ASAP, atypical small acinar proliferation; and AAH, atypical adenomatous hyperplasia), PSA velocity of 0.75 ng/ml per year or more, PSA density of 0.15 ng/ml/ccm or more, and free/total P.A ratio less than 18%. Twenty-one (32%) patients had positive biopsies for prostate cancer, and the rest of 43 (68%) patients were diagnosed as having benign prostate hyperplasia, inflammation, normal prostate tissue, or suspect lesions. When stratified according to anatomic location of positive cores, 19.1% of patients had isolated transition zone tumors on repeat biopsy, and 28.6% had both transition and peripheral zone tumors. A total of 23 (35.93%) patients with premalignant lesions on initial biopsy were also included. Of these, repeat biopsy pathologic specimens indicated malignancy in nine (39.1%) patients. There is a significant false-negative rate for initial transrectal ultrasound guided biopsy. Therefore, repeat biopsy is recommended in all patients who meet the criteria for transrectal ultrasound guided biopsy and in those in whom initial biopsy is negative. Also, classic sextant biopsy laterally plus two cores from each transition zone of the prostate is recommended to reduce the false-negative rate in repeat biopsies due to the high detection rate of cancer in the transition zone of the prostate. Recent literature on the topic is reviewed and discussed.U članku se opisuju vlastiti rezultati kod prve ponavljane, transrektalnim ultrazvukom vođene biopsije prostate, uz poseban osvrt na učestalost novodijagnosticiranog karcinoma u prijelaznoj zoni. Ponavljane transrektalnim ultrazvukom vođene biopsije prostate (6 cilindara lateralno i 2 iz prijelazne zone) učinjene su u 64 bolesnika. Indikacije za ponavljanu biopsiju prostate bile su tvrdokorno povišene vrijednosti za prostatu specifičnog antigena (PSA), brzina porasta PSA kroz godinu dana, gustoća PSA veća od 15 ng/ml/ccm i omjer slobodno i ukupnog PSA manji od 18%, prethodna biopsija s predmalignim lezijama, te sumnjivi digitorektalni nalaz. U 21 (32%) bolesnika na ponavljanoj biopsiji otkriven je karcinom prostate, a u ostalih 43 (68%) nalaz je bio upala, benigna prostatična hipertrofija ili predmaligna lezija. U 19,1% bolesnika na ponavljanoj biopsiji tumor je zabilježen u prijelaznoj zoni, a u 28,6% tumor je nađen u prijelaznoj i perifernoj zoni. U 23 (35,93%) bolesnika s predmalignim lezijama na inicijalnoj biopsiji učinjena je ponavljana biopsija, te je karcinom prostate otkriven u 9 (39,1%) bolesnika. Na inicijalnoj biopsiji prostate značajan je broj lažno negativnih nalaza. Ponavljana transrektalnim ultrazvukom vođena biopsija preporuča se u svih bolesnika koji zadovoljavaju kriterije za biopsiju prostate, te u kojih je inicijalna biopsija negativna. Također se preporuča učiniti klasičnu sekstant biopsiju lateralnije uz dva dodatna cilindra iz prijelazne zone prostate upravo zbog visoke razine otkrivanja karcinoma u prijelaznoj zoni. Prikazan je i kritički pregled novije literature o ovoj problematici

Primarni ekstragonadni tumori zametnih stanica u odraslih: prikaz triju slučajeva

Primary extragonadal germ cell tumors are rare neoplasms affecting young males. They usually present with abdominal retroperitoneal, mediastinal mass with varying symptoms. The rarest among these rare extragonadal germ cell tumors are embryonal cell carcinomas. Three cases of embryonal cell carcinomas are presented to show that the clinical presentation of this treatable tumor in this patient population may be quite unusual and difficult to diagnose. Differentiation between primary extragonadal tumors and metastasis of testicular primary tumor is essential but may be difficult in many instances.Primarni ekstragonadni tumori su rijetke neoplazme koje pogađaju uglavnom mlađe muškarce. Obično se očituju kao abdominalne retroperitonejske ili medijastinalne mase s različitim simptomima. Najrjeđi među rijetkim ekstragonadnim tumorima zametnih stanica su embrionalni karcinomi. Tri prikazana slučaja embrionalnih karcinoma pokazuju da kliničko očitovanje ovih tumora može biti neuobičajeno, a postavljanje dijagnoze otežano. Razlikovanje primarnih ekstragonadnih tumora i metastaza primarnog tumora testisa je ključno, ali u mnogim slučajevima problematično

Transuretralna incizija prostate: objektivna i subjektivna procjena učinkovitosti kroz devet godina praćenja

Long term efficacy of transurethral incision of the prostate (TUIP) was evaluated in selected patients. A total of 50 patients with symptoms of bladder outlet obstruction caused by smaller benign prostates (estimated weight 30 g or less) were assigned to TUIP. Bilateral incision at "5 and 7" o\u27clock position was performed in all patients. Preoperative and postoperative evaluation included total urinary symptom score (I-PSS), uroflowmetry, patient overall assessment of surgery outcome, and sexual function questionnaire. The mean follow-up time was 66 months (6 to 108 months). Improvements in the mean urinary peak flow rates were observed in all cases. Postoperative total as well as irritation and obstructive symptom scores decreased significantly. All of 28 patients who had been sexually active before surgery retained their sexual activity after surgery, and only one (3.6%) of these had retrograde ejaculation. In comparison to other studies, where patients with bladder outlet obstruction caused by small prostate underwent classic transurethral resection of prostate (TURP), TUIP appeared to be faster, technically easier, and associated with lower morbidity. The results of this study clearly demonstrated TUIP to be an effective treatment for bladder outlet obstruction caused by small prostates in all patients, especially younger men, those with normal sexual activity, and patients at high operative risk. The method showed comparably good long term outcome as TURP, but with less complications.U radu su procijenjeni rezultati transuretralne incizije prostate (TUIP) na duži rok kod selekcioniranih bolesnika. Kod 50 bolesnika sa simptomima subvezikalne opstrukcije, koji su bili uzrokovani malom benignom prostatom (procijenjena težina 30 grama ili manja) učinjen je TUIP. Kod svih bolesnika učinjene su bileteralne incizije na .5 i 7. sati. Prijeoperacijska i poslijeoperacijska procjena kroz intervale praćenja obuhvaćala je ukupnu ocjenu težine simptoma (I-PSS), mikciometriju, ocjenu zadovoljstva bolesnika rezultatom operacijskog zahvata, te upitnik o seksualnim funkcijama. Poboljšanje srednjih vrijednosti maksimalne brzine protoka bilo je vidljivo u svih bolesnika. Poslijeoperacijski ukupni, iritativni i opstruktivni zbroj simptoma pao je značajno u svim razdobljima praćenja. Kod svih 28 bolesnika koji su prijeoperacijski bili seksualno aktivni potencija je sačuvana poslijeoperacijski, a samo je jedan bolesnik signalizirao retrogradnu ejakulaciju. Rezultati ispitivanja uspoređeni su s rezultatima studija transuretralne resekcije (TURP) malih prostata objavljenim u dostupnoj literaturi. TUIP je učinkovita metoda liječenja male benigne prostate, poglavito u mlađih, seksualno aktivnih te visokorizičnih bolesnika, s podjednako dobrim rezultatima na duži rok kao kod TURP-a, ali s puno manje komplikacija

Evolution of the Clinical Presentation and Outcomes after Radical Prostatectomy for Patients with Clinically Localized Prostate Cancer – Changing Trends over a Ten Year Period

We demonstrate the evolution of the clinical presentation and outcomes for patients with clinically localized prostate cancer (PC) treated with radical retropubic prostatectomy (RRP) at our department, emphasizing epidemiologic significance of changes during the 10-year period.We assessed the annual trends for changes in patients age, preoperative prostate specific antigen (PSA), preoperative versus postoperative stages and Gleason grades, organ confined status and surgical margin status. A total of 488 RRPs were performed from January 1996 to December 2005 with the annual frequency increased from 8 to 129 (1512.5%). Mean patient age increased from 61.5 to 66.12 years in 2005, with the percentage of men aged more than 70 years increased from 12.5 to 26.5%, respectively. The detection of PC based solely on pathological PSA levels (as indication for prostate biopsy) rose impressively from 25.5 to 70% and the rates of postoperative organ- confined disease also increased significantly from 25 to 74.7%. Mean preoperative PSA decreased from 16.7 to 9.89 ng/mL. On the contrary, there was an increase in percentage of patients with preoperative PSA values ranging from 4 to 10 ng/mL (from 20 to 65.4%). Positive surgical margin rate decreased from 49.4 to 25% and percent of patients receiving neoadjuvant therapy decreased from 78.5 to 5.4%. Proportion of patients who were undergraded decreased from 75.1 to 31.7%. The rates of understaging have remained relatively stable over the years. During the study period, PC was increasingly detected by prostate biopsy on the basis of a pathological PSA level only and shifted significantly to more organ- confined stages with more favourable outcomes for pathological variables due to a more accurate assessment of clinical stage prior to surgery, reduced use of neoadjuvant therapy and improved surgical technique. Our data also argue strongly that routine PSA testing should be expanded and not restricted

Primarni ekstragonadni tumori zametnih stanica u odraslih: prikaz triju slučajeva

Primary extragonadal germ cell tumors are rare neoplasms affecting young males. They usually present with abdominal retroperitoneal, mediastinal mass with varying symptoms. The rarest among these rare extragonadal germ cell tumors are embryonal cell carcinomas. Three cases of embryonal cell carcinomas are presented to show that the clinical presentation of this treatable tumor in this patient population may be quite unusual and difficult to diagnose. Differentiation between primary extragonadal tumors and metastasis of testicular primary tumor is essential but may be difficult in many instances.Primarni ekstragonadni tumori su rijetke neoplazme koje pogađaju uglavnom mlađe muškarce. Obično se očituju kao abdominalne retroperitonejske ili medijastinalne mase s različitim simptomima. Najrjeđi među rijetkim ekstragonadnim tumorima zametnih stanica su embrionalni karcinomi. Tri prikazana slučaja embrionalnih karcinoma pokazuju da kliničko očitovanje ovih tumora može biti neuobičajeno, a postavljanje dijagnoze otežano. Razlikovanje primarnih ekstragonadnih tumora i metastaza primarnog tumora testisa je ključno, ali u mnogim slučajevima problematično

Transuretralna incizija prostate: objektivna i subjektivna procjena učinkovitosti kroz devet godina praćenja

Long term efficacy of transurethral incision of the prostate (TUIP) was evaluated in selected patients. A total of 50 patients with symptoms of bladder outlet obstruction caused by smaller benign prostates (estimated weight 30 g or less) were assigned to TUIP. Bilateral incision at "5 and 7" o\u27clock position was performed in all patients. Preoperative and postoperative evaluation included total urinary symptom score (I-PSS), uroflowmetry, patient overall assessment of surgery outcome, and sexual function questionnaire. The mean follow-up time was 66 months (6 to 108 months). Improvements in the mean urinary peak flow rates were observed in all cases. Postoperative total as well as irritation and obstructive symptom scores decreased significantly. All of 28 patients who had been sexually active before surgery retained their sexual activity after surgery, and only one (3.6%) of these had retrograde ejaculation. In comparison to other studies, where patients with bladder outlet obstruction caused by small prostate underwent classic transurethral resection of prostate (TURP), TUIP appeared to be faster, technically easier, and associated with lower morbidity. The results of this study clearly demonstrated TUIP to be an effective treatment for bladder outlet obstruction caused by small prostates in all patients, especially younger men, those with normal sexual activity, and patients at high operative risk. The method showed comparably good long term outcome as TURP, but with less complications.U radu su procijenjeni rezultati transuretralne incizije prostate (TUIP) na duži rok kod selekcioniranih bolesnika. Kod 50 bolesnika sa simptomima subvezikalne opstrukcije, koji su bili uzrokovani malom benignom prostatom (procijenjena težina 30 grama ili manja) učinjen je TUIP. Kod svih bolesnika učinjene su bileteralne incizije na .5 i 7. sati. Prijeoperacijska i poslijeoperacijska procjena kroz intervale praćenja obuhvaćala je ukupnu ocjenu težine simptoma (I-PSS), mikciometriju, ocjenu zadovoljstva bolesnika rezultatom operacijskog zahvata, te upitnik o seksualnim funkcijama. Poboljšanje srednjih vrijednosti maksimalne brzine protoka bilo je vidljivo u svih bolesnika. Poslijeoperacijski ukupni, iritativni i opstruktivni zbroj simptoma pao je značajno u svim razdobljima praćenja. Kod svih 28 bolesnika koji su prijeoperacijski bili seksualno aktivni potencija je sačuvana poslijeoperacijski, a samo je jedan bolesnik signalizirao retrogradnu ejakulaciju. Rezultati ispitivanja uspoređeni su s rezultatima studija transuretralne resekcije (TURP) malih prostata objavljenim u dostupnoj literaturi. TUIP je učinkovita metoda liječenja male benigne prostate, poglavito u mlađih, seksualno aktivnih te visokorizičnih bolesnika, s podjednako dobrim rezultatima na duži rok kao kod TURP-a, ali s puno manje komplikacija

Razvoj parcijalne nefrektomije zbog tumora bubrega – napuštamo li osnovna načela Robsonove radikalne nefrektomije?

Fifty years ago, Robson introduced radical nephrectomy (RN ) setting the gold standard for treating kidney tumors. Experience has shown that partial nephrectomy (PN) can be equally effective with the advantages of preserving kidney function and avoiding unnecessary nephrectomies for benign tumors. The purpose of this report is to demonstrate the evolution of clinical presentation and choice of treatment for patients with kidney tumors at our department, emphasizing changes in the PN utilization trends. Clinical data were abstracted for the years 2002, 2007 and 2012. We assessed annual trends for changes in the choice of operative treatment related to tumor size, pathologic stage and diagnosis. During the study, there was an increase in the share of T1 tumors, from 46.6% in 2002 to 69.8% in 2012. The rate of PN increased more than ten-fold, from 2.7% in 2002 to 31.7% in 2012. The annual rates of PN for T1 tumors increased even more, from 6.6% in 2002 to 46.7% in 2012. Opposite to RN group, there was an increase in the mean tumor size in PN group (from 1.8 cm in 2002 to 3.9 cm in 2012). The rate of RN for benign tumors was reduced impressively from 85.7% in 2002 to 23.1% in 2012. Our data argue strongly that PN should be expanded and not restricted. Robson’s principles have been partially deserted over the last decade; however, proving that PN is superior to RN still remains to be elucidated.Prije 50 godina Robson je izveo prvu radikalnu nefrektomiju (RN ) te time postavio zlatni standard za kirurško liječenje tumora bubrega. Iskustvo je pokazalo da je parcijalna nefrektomija (PN) jednako učinkovita s prednostima očuvanja bubrežne funkcije i izbjegavanjem nepotrebne nefrektomije zbog dobroćudnih tumora. U radu se prikazuju promjene kliničke slike i napredak u izboru operativnog liječenja tumora bubrega na našoj klinici, naglašavajući razvoj indikacija za primjenu PN. Studija je obuhvatila sve bolesnike koji su operativno liječeni zbog tumora bubrega na našoj klinici u 2002., 2007. i 2012. godini. Analizirali smo izbor operativne metode u danim razdobljima prema veličini tumora, stadiju bolesti i dijagnozi.U promatranom razdoblju porastao je udio tumora T1, s 46,6% u 2002. na 69,8% u 2012. godini. Od ukupnog broja operiranih bolesnika u 2002. godini 2,7% ih je operirano metodom PN, dok je u 2012. taj udio bio 32%, što predstavlja porast veći od 10 puta. Porast godišnjeg udjela PN za stadij bolesti T1 bio je još veći, sa 6,6% u 2002. na 46,7% u 2012. godini. Za razliku od skupine RN , u skupini PN zabilježen je porast prosječne veličine tumora s 1,8 cm u 2002. na 3,9 cm u 2012. godini. Impresivno je smanjenje RN kod bolesnika s dobroćudnom patologijom koja je u 2002. godini iznosila 85,7%, a u 2012. samo 23,1%. Rezultati našega istraživanja pokazuju da indikacije za PN treba proširivati, a ne ograničavati. U zadnjih 10 godina Robsonova načela su djelomice napuštena, ali superiornost PN nad RN tek treba dokazati