Jagdeesh N. Kulkarni

Prophylactic bilateral groin node dissection versus prophylactic radiotherapy and surveillance in patients with N0 and N1-2A carcinoma of the penis.

Sixty-four patients with carcinoma of the penis and clinically negative nodes (N0, N1-2a) had either bilateral groin node dissection (BGND), radiotherapy (RT) to the groin or surveillance in a prospective nonrandomized study on a sequential basis. The tumors were classified according to TNM staging and showed T1, T2 and T3 lesions in 24, 20, 20 patients, respectively, while their node status was N0 in 37 and N1-2A in 27 patients. The tumor grade was G1, G2 and G3 in 10, 30 and 24 patients, respectively. Of these patients 27 had BGND, 18 RT and 19 surveillance. The BGND group showed positive nodes in 4 (14%) patients: 1 with T2 and 3 with T3, and 2 each with N0 and N1-2A status. The 5-year survival was analyzed in terms of primary (T), node status (N), and grade (G) of the tumor and showed 79, 75 and 50% in G1, G2 and G3 tumors, respectively. The overall 5-year survival rate was 74, 66 and 63%, in the BGND, RT and surveillance groups, respectively. Furthermore, analysis of the survival rates in relation to the T and N status in the 3 treatment groups showed identical survival rates for the T category, but for the N category N0 patients had a significantly higher survival rate in the BGND group when compared with the others. In the follow-up relapses occurred in 10 (15%) patients: 7, 2 and 1 in the surveillance, RT and BGND groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

RADICAL CYSTOPROSTATECTOMY: AN EXTRAPERITONEAL RETROGRADE APPROACH

PURPOSE We describe a new technical approach for the surgical management of bladder cancer. MATERIALS AND METHODS Patients with invasive bladder cancer underwent radical cystoprostatectomy using a technically different approach than the conventional method. The important features of this modification include a small infraumbilical incision, completely extraperitoneal dissection to maintain the bowel loops away from the operating field, urethral dissection performed earlier in the operation rather than at the end to preserve the striated urethral sphincter with the neurovascular bundles, completely retrograde dissection of the rectovesical plane for increased safety and reperitonealization done at completion to isolate the urinary anastomoses from the bowel anastomosis. RESULTS More than 50 consecutive patients with early bladder cancer underwent this operation during a 2-year period. The technique was safe and satisfactory. CONCLUSIONS Radical retrograde extraperitoneal cystoprostatectomy is based on a finer knowledge of anatomy. It requires accurate dissection, making it inherently superior to the conventional method.

Carcinoma in the third testis in a case of polyorchidism and persistent Müllerian structure syndrome

Polyorchidism is a rare anomaly and neoplasia arising in a supernumerary testis is even rarer. We herein describe a case of tumor in a supernumerary abdominal testis in an adult male with unrecognized persistent müllerian structure syndrome.

Autonomous aldosterone-secreting ovarian tumor

The case of a young woman with primary aldosteronism originating extraadrenally--ovarian tumor--is reported. Clinically she presented with uncontrolled hypertension. Biochemical and hormonal profiles showed features of aldosteronism. The primary was found in the left ovary. Following excision of the tumor, aldosteronism regressed completely. Microscopically, the tumor was of the lipid cell type. Nine months after surgery she is asymptomatic and well. Review of the literature uncovered three previous reports of aldosterone-secreting ovarian tumors.

Bilateral Synchronous Tumors in Testes in Unrecognized Mixed Gonadal Dysgenesis: A Case Report and Review of Literature

A case of germ cell tumor occurring simultaneously in the descended and undescended testes of an infertile phenotypic man is reported. Cytogenetic studies revealed a 46XY pattern. Exploration of the abdomen showed a left testicular mass in close proximity to a rudimentary uterus, a fallopian tube and a right testicular mass in the scrotum. Complete excision of both testicular masses and the uterus with the adnexa was done. Histologically, both tumors were seminoma. The patient was well 2 years after treatment.

IMPROVED MANAGEMENT OF ABDOMINAL UNDESCENDED TESTICULAR TUMORS WITH BULKY CONFLUENT RETROPERITONEAL NODAL METASTASES

PURPOSE Germ cell tumors of the abdominal undescended testis associated with confluent bulky retroperitoneal metastases are challenging problems. We report the results of neoadjuvant cisplatin based chemotherapy after diagnosis of germ cell tumors by fine needle aspiration cytology of the abdominal testicular mass. After chemotherapy all patients underwent abdominal orchiectomy with retroperitoneal lymph node dissection for residual nonseminomatous germ cell tumors or radiotherapy for pure seminomas. MATERIALS AND METHODS Between 1980 and 1991, 57 of 425 patients (13.4%) with germ cell tumors of the testicle had malignancy in an undescended testis, while 39 (68.4%) had tumor in an abdominal testis with confluent bulky metastasis. Metastatic evaluation included tumor marker studies, chest x-ray and computerized tomography of the abdomen. Among the tumors 29 (74.4%) were large volume seminomas (stages IIc, III and IV) and 10 (25.6%) were large volume nonseminomas. All 39 patients received 3 cycles of induction chemotherapy, and orchiectomy was deferred until its completion (14 received vinblastine, actinomycin D and bleomycin-6, and 25 received bleomycin, etoposide and cisplatin). After evaluation of response, the testis was excised. Overall followup was 2 to 12 years (median 4.6). RESULTS Of 29 seminomas 14 (48.3%) showed a complete and 11 (37.9%) showed a partial response. The latter tumors were treated subsequently with radiotherapy. Four patients with progressive disease died, for an actuarial survival rate of 86%. Of the 10 patients with nonseminomatous germ cell tumor 2 (20%) had a complete response and 4 had a partial response. All patients with a partial response underwent retroperitoneal lymph node dissection. Overall, 4 patients with progression and 2 with a partial response died, for an actuarial survival rate of 39%. Of 39 post-chemotherapy orchiectomy specimens 24 (61.5%) showed viable tumor cells. Furthermore, 16 of 39 patients (41%) had additional ilioinguinal metastases requiring adjuvant radiotherapy or surgery. CONCLUSIONS Surgical removal of the primary tumor in an undescended testis with bulky metastasis is difficult. We believe that initial chemotherapy followed by 1-stage surgical removal of the primary and residual metastasis is a favorable option to improve compliance and decrease the incidence of loss to followup. Atypically altered ilioinguinal metastases may necessitate a change in radiotherapy ports and/or retroperitoneal lymph node dissection boundaries. The significantly poorer survival with nonseminomatous germ cell tumor could be due to the fact that 50% of the lesions were stage IV at presentation. However, multivariate analysis showed only tumor histology to be the significant parameter and not initial stage at presentation.

BLADDER LEIOMYOMA IN PREGNANCY : A CASE REPORT

We herein report a rare case of an asymptomatic bladder mass seen during pregnancy in a young woman. A hypogastric mass was detected at antenatal checkup in the 7th month of pregnancy. The mass increased in size as the pregnancy went to term. Three months after normal delivery, she underwent surgery and a tumor arising from the bladder wall was excised completely. Histology showed a symplastic leiomyoma.

Primary Endodermal Sinus Tumor of the Penis: A Case Report

We report a case of primary extragonadal germ cell tumor of the penis in a 2-year-old child with elevated serum alpha-fetoprotein. The patient responded well to a combination of bleomycin, etoposide and cisplatin, achieving a complete response within 3 cycles. He was alive and disease-free 8 months after diagnosis. To our knowledge this is the first case of an endodermal sinus tumor of the penis reported in the literature. The possible histogenesis of this tumor at such a rare site is discussed.

Solitary metastasis to pubic bone from germ cell tumor of the testis: a case report.

A rare case of solitary pubic bone metastasis from nonseminomatous germ cell tumor of the testis is reported and the relevant literature is reviewed.

Value of tumor markers in nonseminomatous germ cell tumor of the testis

We herein report 8 years experience in the management of nonseminomatous germ cell tumor of the testis with 2 serum markers: alpha-fetoprotein (AFP) and human chorionic gonadotropin (hCG)). In the first 4-year period (group I) marker status was correlated retrospectively to the positivity of nodes and response to treatment. Of the 81 patients in group I, 22, 29 and 30 were in stages I, IIab, and IIc, III and IV, respectively. Of them, 5, 25 and 24 from the respective stages showed raised markers, while 17, 4 and 6 of the same stages had normal markers. The accuracy of the markers in predicting the positivity of the nodes and response to treatment ranged from 80 to 92% in different stages. In the second 4-year period (group II) markers were included in staging. Of the 85 patients in this group, 31 were classified as stage I; however, 25 of them had normal markers and 6 had raised markers (subcategorized as IM). Of the remaining 54 patients, 15 were in stage IIab and 39 in stages IIc, III and IV. In the final analysis, 3-year survival was 66% in stage IM as compared to 100% in the remaining stage I patients and 86% in stage IIab, indicating the aggressive nature of IM disease. Amongst stage IIc, III and IV patients, 28 (71%) patients responded to treatment and 3-year survival in them was 71% (20/28). Of the remaining 11 patients who did not respond to treatment in the form of persistently raised markers, the 3-year survival was 18% (2/11).(ABSTRACT TRUNCATED AT 250 WORDS)