A. Richard Kendall

Immunoperoxidase localization of prostate-specific antigen

In instances of metastatic tumor from an unknown primary site, it is important to isolate those cases which are attributable to prostatic carcinoma. Immunoperoxidase localization of human prostate-specific antigen (PSA) would be useful in this regard if it were reliably detectable in prostatic carcinoma. We have studied 15 specimens from 14 patients with carcinoma of the prostate by immunoperoxidase techniques. The presence of PSA correlates with the Gleason grade. All cases of Gleason grade 9 or less demonstrated strong staining for PSA. Of the seven specimens with a Gleason grade 10, only four (57%) demonstrated significant staining, while two were entirely devoid of PSA. PSA is thus useful when it is present, but the absence of PSA in a poorly differentiated tumor of undetermined origin does not unequivocally rule out the possibility of a prostatic carcinoma.

Spontaneous Subcapsular Renal Hematoma: Diagnosis and Management

Spontaneous subcapsular or perinephric hematoma in the absence of anticoagulation, arteritis or trauma is most likely due to an underlying renal tumor. Eight such patients recently have been evaluated and after nephrectomy 5 had small tumors undetectable by imaging techniques, including computerized tomography or angiography. In 1 patient a tumor was demonstrated preoperatively by angiography and in only 2 was a tumor not found. In the absence of an apparent etiology, patients with spontaneous renal bleeding and a normal contralateral kidney should undergo radical nephrectomy because of the extremely high incidence of small undetectable occult tumors, often less than 2 cm. in size.

The Association of Inverted Papilloma and Transitional Cell Carcinoma of the Urothelium

Inverted papilloma generally is considered a benign lesion, with recurrence documented in only 1 case. However, the association of typical transitional cell carcinoma and inverted papilloma in a single lesion has been reported rarely. We present 1 such case and review the literature. Treatment recommendations are included.

Segmental infarct of the testis due to hypersensitivity angiitis

We present a case of hypersensitivity angiitis causing a segmental infarction of the testis. The lesion presented as a discrete, palpable mass that led to orchiectomy. Hypersensitivity angiitis has not been reported previously to affect the testes or to produce a segmental infarct in any solid organ. A discussion is given of the vasculitides, especially periarteritis nodosa, that may involve the testes.

Blood group antigens and bladder carcinoma: A perspective

A review of the current literature relative to the measurement of blood group antigens on bladder epithelium is presented. The determination of the presence or absence of such antigens on bladder tumors has enabled us to separate patients into two predictive groups at a time when their routine histologic patterns are identical. Group I consists of those patients with detectable blood group antigens by specific red cell adherence testing (SRCA). Regardless of the grade of their lesion, these patients have a low incidence (0-19%) of the ultimate development of invasive disease. Group II consists of those patients without demonstrable blood group antigens on their bladder carcinomas. These patients have a 60 to 93 per cent change of invasive disease developing within five years. Treatment thus can be predicated not only on the grade and stage, but also on a prediction of future behavior. Studies mapping cystectomy specimens, as well as those studying random mucosal biopsies, have shown that when the primary tumor lacks demonstrable blood group antigens, other areas of the bladder are also SRCA negative. These findings may help explain the frequent recurrences and ultimate development of invasive lesions in some of these patients. The role of the measurments of blood group antigens in urine cytology is reviewed, as well as those situations in which red cell adherence may be less definitive, i.e., those patients with carcinoma in situ, after radiotherapy, or thiotepa, and in those patients with blood group O. Future areas of usefulness of blood group antigens are discussed including other organs, i.e., kidney, renal pelvis, testes, and prostate.

Necrotic testicle with increased blood flow on doppler ultrasonic examination

A twelve-year-old male with a five-day history of scrotal swelling and pain had increased blood flow on ultrasonic examination. A testicular flow and scan indicated an ischemic testicle. Surgical exploration revealed complete torsion of the spermatic cord. In chronic cases of torsion, the Doppler stethoscope may give a false negative result because of reactive hyperemia.

Congenital Pelvic Arteriovenous Malformation with Massive Prostatic Hemorrhage: A Case Report

Congenital arteriovenous malformations in the true pelvis are extremely rare: only 7 cases have been described in male patients. We report on a patient who presented with massive hemorrhage after transrectal prostatic biopsy and transurethral resection of the prostate. Diagnosis was established by means of magnetic resonance imaging and confirmed by arteriography. Our attempt at management by embolization and subsequent surgical ligation is described. A literature review and discussion of arteriovenous anomalies are presented.

Scrotal imaging in the Henoch-Schönlein syndrome.

Testicular involvement in patients with Henoch-Schönlein syndrome may occur in as high as 15 per cent of the cases. Scrotal imaging is extremely accurate in differentiating hyperemia (vasculitis) from impairment of blood flow encountered in torsion of the spermatic cord, the most common cause of acute scrotal swelling in children.

Renoduodenal Fistula in a Patient with Chronic Nephrostomy Drainage: A Case Report

We describe the occurrence of a renoduodenal fistula related to a nephrostomy tube in a patient with xanthogranulomatous pyelonephritis and renal calculi. The patient was successfully treated by nephrectomy. Etiological, diagnostic and therapeutic aspects are discussed.

Fluorescence of testicle: An indication of viability of spermatic cord after torsion

We present an objective measure of testicular viability intended to aid the surgeon in salvaging the testicle at the time of operation for torsion of the spermatic cord. Following the intravenous administration of 5 to 10 cc. of sodium fluorescein, the viability of the untwisted testicle can be determined by its fluorescence when exposed to a portable long wavelength Wood ultraviolet light source.