Abstract Spindle cell tumors of the prostate are rare and mostly primary. We report a case of retroperitoneal sarcoma, which is a low-grade fibromyxoid sarcoma involving the prostate secondarily by ...metastasis. The patient was a 44-year-old man who presented with progressing abdominal pain. Computed tomography showed a large retroperitoneal mass. The patient underwent surgical resection. Intraoperatively, a second smaller mass was identified in the pelvis and was left untouched. The resected retroperitoneal specimen and prostate transrectal needle biopsies taken afterward showed the same mesenchymal tumor. Radical cystoprostatectomy was performed. Metatatic tumor involving the prostate, bilateral seminal vesicles, and base of the urinary bladder was found. Microscopic examination revealed typical histomorphologic features of low-grade fibromyxoid sarcoma. The patient is without evidence of disease 3 years postoperatively. This case is the first documentation of metastatic sarcoma to the prostate and expands the list of malignant mesenchymal neoplasms that may involve this organ.
Nonsecretory multiple myeloma (NSMM) is the absence of a detectable monoclonal protein in serum and urine of a multiple myeloma (MM) patient and immunoglobulin light chain (AL) amyloidosis is a ...significantly rare complication. A case of NSMM with AL amyloidosis and nephrotic range proteinuria is presented. Sharing clinical, therapeutic, and prognostic characteristics with MM, real challenge may be during initial diagnosis of NSMM and assessment of treatment response. In elderly patients with unexplained renal dysfunction, MM should be in the differential diagnosis and the absence of a monoclonal protein should not rule out MM but should remind us of the possibility of NSMM.
Objective: To reveal possible associations between non-malignant bladder disease and malignancy by evaluating the pathologic examination results of patients who underwent cystectomy for non-malignant ...diseases and to suggest a point of view for disease management. Materials and Methods: Medical records of patients, who underwent cystectomy in our clinic between January 2005 and January 2015 for non-malignant diseases, were examined retrospectively. Results: A total of 14 patients were included in the study. The mean age of the patients was 58.7±9.3 years. Of the patients eight of them were followed up with interstitial cystitis (IC), five with neurogenic bladder and one with hemorrhagic cystitis. Time from diagnosis to cystectomy was 6.1±5.8 years on average in IC patients, 13.8±9.8 years in neurogenic bladder patients and 10 years in hemorrhagic cystitis patients. No malignancy finding was observed according to the pathologic examination results of the cystectomy specimens. However, either chronic or active inflammation was observed in all the patients. In addition to other pathologies non-keratinized squamous metaplasia was detected in five patients. Conclusion: Patients with non-malignant diseases should be followed-up with cystoscopy and bladder biopsy as a pre-malign lesion caution. Although cystectomy and urinary diversion are surgery methods with high complication rates, they could be suggested to well-informed patients as treatment alternatives.
Ureteritis cystica (UC) is a benign condition. Although it can often be diagnosed with imaging techniques, we report a case of a child for whom we planned nephrectomy and ureteral augmentation ...cystoplasty, but abandoned the cystoplasty due to extensive UC in the ureter.
The prognostic value of the type and extent of extracapillary proliferation (ECP) in pauci-immune necrotizing crescentic glomerulonephitis (PIGN) was evaluated in this study.
In 141 PIGN cases, all ...glomeruli with ECP were grouped according to type (cellular, fibrocellular and fibrous) and extent of the lesions in Bowman's space; (segmental, semicircumferential and circumferential, which might be termed full moon-FM). Cases with cellular and fibrous lesions involving ≥50% of glomeruli with ECP were classified as cellular and fibrous groups, respectively, while the remaining cases were classified as fibrocellular. Cases with segmental and circumferential (FM glomerulus) lesions involving ≥50% of glomeruli with ECP were classified as ECPI and ECPIII (FM) groups, respectively, while the rest were classified as ECPII. All the cases were classified according to Berden et al.
Significant results were only nearly obtained for the FM group, including the need for dialysis. The Cox regression model revealed a 2.6-fold risk for FM cases regarding dialysis requirement.
We propose that the percentage of FM glomeruli should be noted in the pathology report, and cases with more than 50% of FM glomeruli (FM group) should be identified in the group with increased risk of dialysis requirement. Our series also suggests that classification according to Berden et al. is of clinical relevance.
Abstract Objectives We evaluated the clinical outcome and factors affecting survival in patients with renal cell carcinoma (RCC) and tumor thrombus involving inferior vena cava (IVC). Methods Between ...1990 and 2007, 28 patients with RCC and tumor thrombus extending into IVC underwent radical nephrectomy and thrombectomy. Patient data were reviewed retrospectively to evaluate the demographics, clinical presentation, surgical approach, pathological features, clinical outcomes, and survival. Results Twenty-eight patients with a mean age of 52.7 years were operated. Thrombus level was infrahepatic in 15 patients (54%), intrahepatic in 3 patients (10%), suprahepatic in 3 patients (10%), supradiaphragmatic in 2 patients (8%), and intracardiac in 5 patients (18%). All patients with intracardiac thrombi underwent cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA). The mean tumor size was 98.21 mm. Four patients had distant metastases and 3 patients had lymph node involvement. Pathological examination revealed RCC of clear cell type in 26 patients, papillary in 1 and chromophobe in 1 patient. At a mean follow-up of 36.4 months, 16 patients were still alive while 8 patients died due to disease progression and 2 patients died of other causes. Two patients died of pulmonary emboli in the early postoperative period. Lymph node involvement, distant metastases, hypercalcemia, and sarcomatoid component were found to be factors affecting overall survival significantly. Level of tumor thrombus and Fuhrman grade did not affect survival. Conclusions Radical nephrectomy and tumor thrombectomy is currently known to be the most effective method in patients with RCC and tumor thrombus extending into IVC. Factors affecting survival are the ones related to tumor biology. Tumor thrombus level does not affect the prognosis.
As the number of patients living with kidney failure grows, the need also grows for kidney transplantation, the gold standard kidney replacement therapy that provides a survival advantage. This may ...result in an increased rate of transplantation from HLA‐mismatched donors that increases the rate of antibody‐mediated rejection (AMR), which already is the leading cause of allograft failure. Plasmapheresis, intravenous immunoglobulin therapy, anti‐CD20 therapies (i.e., rituximab), bortezomib and splenectomy have been used over the years to treat AMR as well as to prevent AMR in high‐risk sensitized kidney transplant recipients. Eculizumab and ravulizumab are monoclonal antibodies targeting the C5 protein of the complement pathway and part of the expanding field of anticomplement therapies, which is not limited to kidney transplant recipients, and also includes complement‐mediated microangiopathic hemolytic anemia, paroxysmal nocturnal hemoglobinuria, and ANCA‐vasculitis. In this narrative review, we summarize the current knowledge concerning the pathophysiological background and use of anti‐C5 strategies (eculizumab and ravulizumab) and C1‐esterase inhibitor in AMR, either to prevent AMR in high‐risk desensitized patients or to treat AMR as first‐line or rescue therapy and also to treat de novo thrombotic microangiopathy in kidney transplant recipients.
Abstract Introduction The follow‐up findings of patients who underwent prostate biopsy for prostate image reporting and data system (PIRADS) 4 or 5 multiparametric magnetic resonance imaging (mpMRI) ...findings and had benign histology were retrospectively reviewed. Methods There were 190 biopsy‐naive patients. Patients with at least 12 months of follow‐up between 2012 and 2023 were evaluated. All MRIs were interpreted by two very experienced uroradiologists. Of the patients, 125 had either cognitive or software fusion MR‐targeted biopsies with 4 + 8/10 cores. The remaining 65 patients had in‐bore biopsies with 4–5 cores. Prostate‐specific antigen (PSA) levels below 4 ng/mL were defined as PSA regression following biopsy. PIRADS 1–3 lesions on new MRI images were classified as MRI regression. Results Median patient age and PSA were 62 (39–82) years and six (0.4–33) ng/mL, respectively, at the initial work‐up. During a median follow‐up period of 44 months, 37 (19.4%) patients were lost to follow‐up. Of the remaining 153 patients, 82 (53.6%) had persistently high PSA. Among them, 72 (87.8%) had repeat mpMRI within 6–24 months which showed regressive findings (PIRADS 1–3) in 53 patients (73.6%) and PIRADS 4–5 index lesion persistence in 19 cases (26.4%). The latter group was recommended to have rebiopsy. Of these 19 patients, 16 underwent MRI‐targeted rebiopsy. Prostate cancer was diagnosed in six (37.5%) patients and of these four (25%) were clinically significant (>Grade Group 1). Totally, clinically significant prostate cancer was detected in 4/153 (2.6%) patients followed up. Conclusion Patients should be warned against the relative relaxing effect of a negative biopsy after identification of PIRADS 4–5 index lesion. While PSA decrease was observed in many patients during follow‐up, persistent MRI findings were present in nearly a quarter of patients with persistently high PSA. A rebiopsy is warranted in these patients, with significant prostate cancer diagnosed in a quarter of patients with rebiopsy.
Abstract Objectives This study was carried out to evaluate the impact of the presence of teratomatous component in orchiectomy specimen on complete response rates to primary chemotherapy in a large ...series of patients with stage II nonseminomatous germ cell tumors (NSGCT). Materials and methods Chemotherapy was administered to 113 patients with stage II testicular NSGCT. Resection of retroperitoneal residual tumor masses was performed in all patients with partial response to chemotherapy. Patients were categorized into 2 groups according to presence or absence of teratomatous component in the primary orchiectomy specimen. Results Of patients with teratomatous component in the orchiectomy specimen, 32.1% (17/53) had complete response to primary chemotherapy and of those without teratomatous component 55% (33/60) had complete response ( P = 0.022). Stage IIC patients had lower response rate 28.8% (23/80) compared with IIA and IIB patients ( P = 0.0001). Teratomatous elements were found in retroperitoneal mass in 70.6% of patients with teratomatous component in orchiectomy specimens compared to 36.8% of patients without teratomatous component ( P = 0.022). After retroperitoneal surgery and additional treatments, complete response rate increased to 92.4% and 89.5% in patients with and without teratomatous component in primary pathology, respectively, ( P > 0.05). Conclusions Since teratomatous component in orchiectomy specimen is a predictor of teratoma in the residual retroperitoneal mass, it decreases the response rate to primary chemotherapy and increases the need for postchemotherapy retroperitoneal lymph node dissection (RPLND) in metastatic NSGCT patients.
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