G. Nabi

Primary embryonal rhabdomyosarcoma of prostate in adults: Diagnosis and management

Embryonal rhabdomyosarcoma of the prostate is a common tumour in infants and children. It is rarely seen in adults. The combined modality has improved outcome in children, where as in adults prognosis is poor. The lack of awareness of this entity in adults, delay in diagnosis and a more aggressive behavior of this malignancy are some of the reasons. We report two cases of embroyonal rhabdomyosarcoma of prostate in adults along with review of literature with an aim to define natural history and formulate treatment policy.

Prognostic Significance of p53 Nuclear Overexpression in Patients of Muscle Invasive Urinary Bladder Carcinoma Treated with Cystectomy

Introduction: The objective of the study was to determine the pattern of p53 expression in patients with muscle invasive bladder cancer treated with cystectomy and to assess the prognostic value of p53 expression in this group of patients. Materials and Methods: We retrospectively analyzed data of 100 patients who underwent cystectomy for invasive transitional cell carcinoma of the urinary bladder. These patients were seen at 3-monthly intervals during the first 2 years, 6-monthly in the third year, and yearly thereafter. Immunohistochemical analysis for p53 was done on paraffin-fixed tissues with DO-7 antibodies. The tumours with >30% cells staining for p53 proteins were considered p53 positive. Results: There were 95 males and 5 females with a mean age of 54 years. Two patients died in the perioperative period and were excluded from analysis. Over a median follow-up period of 2 years (range 3 months to 10 years) 62 patients are alive without disease while 36 had relapse and of these, 31 have died. The p53 expression was significantly related to stage and grade of the tumour. p53-negative tumours were more likely to be organ confined and of lower grade as compared to p53-positive tumours. The stage of tumour was significantly related to outcome but grade and p53 immunohistochemistry did not provide any prognostic information. Conclusions: p53 immunostaining was positive in 57% of muscle invasive urinary bladder tumours. The p53 positivity correlated well with the stage and grade of the disease, whereas it has no additional prognostic value.

Eye metastasis form urothelial tumours

Obit is an infrequent site of metastasis from urothelial tumours. To the best of our knowledge there are less than ten case reports of orbital or choroidal metastases from urothelial tumours reported in English medical literature. On the basis of review ofthese reports (Table 1) and experience in managing two more cases, it is emphasized thatnon-specific eye symptoms in patients of urothelial tumours need thorough ophthalmological and radiological evaluation. Herein, we present case descriptions, along with pathophsiology; and review of literature to highlightthe need for early diagnosis and prompt management of this rare clinical event.

Endoscopic Removal of Knotted Urethral Catheter: A Point of Technique

Urethral catheter knotting is a rare complication of the simple and widely practiced clean intermittent self-catheterization. We report the endoscopic retrieval of a retained knotted feeding tube in a 12-year-old child. Various factors leading to such a rare complication and a new minimal invasive technique are described. To the best of our knowledge this technique has not been previously reported in the medical literature.

Conservative Management of Spontaneous Rupture of a Sigmoid Colon Neobladder

A case of successful management of spontaneous perforation of an orthotopic sigmoid colon neobladder 18 months following radical cystectomy for muscle-invasive transitional cell carcinoma is described. Conservative management of such perforations has rarely been described in the literature; however, this is the first case report of sigmoid colon neobladder perforation and of its successful conservative management, to the best of our knowledge.

Solitary Radial Head Metastasis with Wrist Drop: A Rare Presentation of Metastatic Prostate Carcinoma

The fact that a prostate carcinoma metastasizes to the skeleton is well known. The metastatic deposits are generally multiple and osteoblastic. Moreover, these involve the axial skeleton or the proximal part of long bones. A pure osteolytic metastasis from a prostate carcinoma is extremely rare. This is believed to be the 1st case report of a osteolytic solitary radial head metastasis from a prostate carcinoma in a 60-year-old male. The rare clinical presentation of wrist drop, the absence of metastases at any other site, and a significant decrease in the size of lesion on follow-up in response to hormonal therapy are of interest in this case. The rare clinical presentation of a common malignancy (prostate carcinoma) is reported with a brief review of the literature.

Is Incidental Appendectomy Necessary during Radical Cystectomy

Objective: To find out the incidence of acute appendicitis leading to acute abdominal pain and necessitating appendectomy in the follow-up of patients after radical cystectomy and urinary diversions. Methods: A prospective 160 consecutive radical cystectomy patients with urinary diversion in whom appendectomy was not done between January 1991 and June 2001 were reviewed for the incidence of acute appendicitis. Ages ranged between 26 and 73 years. There were 143 males and 17 females. 120 patients had ileal conduit, 20 sigmoid neobladder, 5 continent urinary diversion, and 15 ureterosigmoidostomy as urinary diversion. Each patients was followed up regularly till death or last follow-up. The follow-up ranged between 4 months and 10 years (mean 6 years). Results: Intestinal obstruction (11%) and acute pyelonephritis (16%) were the most common causes of acute abdominal pain. The remaining causes include sigmoid neobladder perforation (0.6%), parastomal hernia (0.6%), urinary retention due to mucus (1.8%) and renal colic (1.8%). In all patients, diagnosis was easily made and they were managed accordingly. None of the patients had acute appendicitis requiring appendectomy on follow-up. Conclusion: Incidental appendectomy is not required during radical cystectomy as the risk of subsequent appendicitis is extremely low.

Malignant anterior urethral strictures: A rare complication of transurethral resection of malignant prostate

A 65-year old male presented with obstructive voiding symptoms and recurrent hematuria following transurethral resection of malignant prostates. Following an unsuccessful attempt at catheterization, urethroscopy revealed narrowing of anterior urethra secondary to multiple nodular lesions. Biopsy of lesion showed adenocarcinoma positive for prostate specific antigen. This rare presentation has been reported only twice in past. Clinical presentation, pathophysiology and brief review of literature are discussed.

Impact of primary tumour characteristics on the survival of patients with lymph node metastases in bladder cancer following radical cystectomy

Background and objective:Patients with carcinoma urinary bladder with metastasis to the lymph nodes have been believed to have a poor prognosis. The various factors affecting survival in this subset of patientsare not well understood. To analyze, thesefactors, we retrospectively analyzed patientswho had undergone radical cysytectomy at ourcenter in the last 10 years.Methods: From Jan. 199l to May 2001, 158patients underwent radical cysytectomy at ourcenter.38 of these were found to havemetastasis in the regional lymph nodes (i.e.stage D). A multivariate regression analysiswas done to look for factors, whichpredict a better survival in this group ofpatients. Patients were studied for age,sex, morphology of tumour (papillary ornodular), grade of tumour, local extent of thedisease (T1 T3A OR T3B), lymph nodalinvolvement, chemotherapy (whether received ornot) and no. of TUR resection before radicalcystectomy. SPSS software was used and theactuarial disease specific survival calculatedfor each variable.Results: There were 33 males and 5 females withan age range of 34–75 years (mean 56). Overallsurvival was 7 months to 84 months withmean of 32 months. Patients with polypoidaldisease had better survival (66 months vs l5months). Also patients with organ-confineddisease (T2, T3a) had better survival thanthose with perivesical spread (T3b). The meansurvival in N1 and N2 disease was 36 and 10months respectively. The benefits of adjuvantchemotherapy (methotrexate and cisplatin) couldnot be assesd as most of the patients receivedchemotherapy.Conclusion: Patients with positive lymph nodesfor metastases have fairly good survival withradical cystectomy especially those who have alower T stage (organ confined), papillarymorphology and N1 disease.

Fungating Scrotal Mass

We present a case of large fungating scrotal mass in a 18-year-old male. Investigations revealed non-seminomatous germ cell tumor with retroperitoneal nodes. Systemic chemotherapy was followed by excision of the mass. This rare presentation is reported here.