Jen-Tai Lin

Ureterosciatic Hernia Causes Obstructive Uropathy

Obstructive uropathy can be caused by urolithiasis, fibrotic ureteral stricture, inflammatory ureteritis with polyp formations, ureteral malignancy and various forms of external compression. Ureteral herniation is a relatively rare cause of obstructive uropathy and has been reported with herniation sites including inguinal canal, femoral canal and sciatic foramen. Most ureteral herniations occur in the inguinal area. In the literature, previous cases of sciatic ureter have been treated with observation in asymptomatic patients or with surgery in patients with obstructive uropathy or clinical symptomatology. We report the case of a 91-year-old female with asymptomatic hydronephrosis of the left kidney due to extremely rare ureterosciatic herniation. Her global renal function was acceptable. As she was elderly and a poor surgical candidate, watchful waiting was recommended after discussion with the patient and her family.

Role of p21WAF1 and p27KIP1 in Predicting Biochemical Recurrence for Organ-confined Prostate Adenocarcinoma

Background: Both p21WAF1 and p27KIP1 have been reported as prognostic markers predicting biochemical failure for prostate cancers. We examined the expression and prognostic significance of p21WAF1 and p27KIP1 in organ‐confined (pT2) prostate cancer patients. Methods: The medical records of 53 pT2 prostate adenocarcinomas were analyzed retrospectively. Radical prostatectomy specimens were stained using anti‐p21WAF1 and anti‐p27KIP1 antibodies. Biochemical relapse was defined as 2 consecutive elevations in serum prostate specific antigen (PSA) level > 0.2 ng/mL with an interval of more than 3 months. The prognostic significance of p21WAF1 and p27KIP1 expression was assessed. Results: p21WAF1 immunoreactivity was found in 19 patients (35.8%). Twenty‐nine tumors (54.7%) had decreased p27KIP1 expression. Both markers were not associated with Gleason scores (p = 1.00 for both). At a median follow‐up of 49 months, 15 patients (28.3%) experienced biochemical recurrence. Both p21 and p27 had no prognostic significance in log‐rank test (p = 0.98 and p = 0.64, respectively). Conclusion: p21WAF1 and p27KIP1 expression have no role in predicting biochemical relapse for stage pT2 prostate cancers.

Expression of Vascular Endothelial Growth Factor in Taiwanese Benign and Malignant Prostate Tissues

Background: The expression of vascular endothelium growth factor (VEGF) has been correlated to the grading and stage of prostate cancers. However, data regarding Taiwanese prostate cancer patients are lacking. The aim of the present study was to examine VEGF expression in our radical prostatectomy specimens. Methods: Fifty‐one radical prostatectomy specimens with prostate cancer (15 stage pT2N0, 25 pT3N0, 11 pT2‐4 N1) were stained using goat anti‐human VEGF polyclonal antibody (AB‐293NA; R&D Systems Inc., Minneapolis, MN, USA). The VEGF expression in malignant and nonmalignant prostate tissues was compared. The correlations of VEGF immunoreactivity with Gleason scores and pathologic stages were examined. Mann–Whitney U test was used for comparison of preoperative prostate‐specific antigen levels between patients with and without VEGF expression. Results: Positive VEGF staining was observed in 80.4% of malignant epithelia, 39.2% of peritumoral stroma, 68.6% of benign hyperplastic glands, and 25.5% of adjacent stroma. There was no difference in VEGF expression between malignant and nonmalignant areas. Advanced disease had significantly higher frequency of stroma but not epithelium VEGF staining as compared to organ‐confined disease (p = 0.002 and p = 0.412, respectively). The Gleason 7 and higher tumors had significantly higher frequency of VEGF staining in stroma but not glandular epithelium (p = 0.041 and p = 0.353, respectively). Tumors with positive epithelium VEGF staining had significantly higher PSA levels (21.3 ± 18.1 vs. 10.8 ± 6.8 ng/mL; p = 0.013). Conclusion: There was no difference in VEGF immunoreactivity between malignant and benign prostatic epithelium in Taiwanese. High Gleason grade tumors and advanced disease had significantly higher frequency of VEGF expression in stroma but not glandular epithelium. Tumors with positive epithelium VEGF staining had significantly higher PSA levels.

Correlation of p53 protein accumulation and Bcl-2 overexpression with histopathological features in prostatic cancer

BACKGROUND AND PURPOSE p53 mutation and Bcl-2 overexpression is correlated with advanced prostate cancer. This study investigated the correlation of p53 and Bcl-2 immunoreactivity frequency with histopathological features in patients with prostate cancer in Taiwan. METHODS Primary adenocarcinomas from 125 radical prostatectomy specimens were stained using commercial monoclonal antibodies. Association between immunohistochemical findings and tumor extent, Gleason score and preoperative prostate-specific antigen (PSA) levels were assessed. RESULTS Abnormal p53 expression was identified in 44 tumors (35.2%) and was correlated with high serum PSA (p=0.022) and advanced disease (p=0.005), but not Gleason score. Ten tumors (8%) expressed Bcl-2. A significant positive association was found between Bcl-2 and PSA (p=0.034). There was no association between p53 and Bcl-2 immunopositivity. CONCLUSIONS p53 mutation was positively correlated with serum PSA and tumor extent. Overexpression of Bcl-2 was associated with high serum PSA only.

Secondary signet-ring cell carcinoma of the prostate.

A 70-year-old man was referred in May 1990 for a left lower ureteral stone. Digital rectal examination demonstrated a moderately enlarged prostate with an irregular surface. Serum prostate specific antigen (PSA) was 6.6 ng./ ml. Ultrasound guided biopsy of the prostate aiming toward the hypoechoic lesion showed nodular hyperplasia. Three years previously the patient had undergone radical gastrectomy for signet-ring cell carcinoma of the stomach (stage pT3N2M0) followed by adjuvant chemotherapy. Followup computerized tomography and radioisotope bone scan revealed absence of tumor. The patient subsequently underwent transurethral resection of the prostate in February 1991 for increasing lower urinary tract symptoms and a PSA of 9.7 ng./ml. Pathological examination demonstrated poorly differentiated signet-ring cell carcinoma with negative PSA staining (figs. 1 and 2). Staging computerized tomography showed infiltrative tumor in a cul-de-sac with direct invasion of the prostate. The patient was managed conservatively. Nine months later he underwent exploratory laparotomy for intestinal obstruction. Generalized tumor seeding to the omentum and cul-de-sac was confirmed at that time.

Ureteroscope-assisted double-J stenting following laparoscopic ureterolithotomy

The aim of this study was to examine the feasibility of ureteroscope‐assisted double‐J stenting following laparoscopic ureterolithotomy and to evaluate the effects of retrograde ureteroscopic access exerted on the sutured ureterotomy site. From January 2002 to December 2011, 30 patients with proximal ureteral stone underwent ureteroscopic double‐J stenting of the ureter following retroperitoneal laparoscopic ureterolithotomy. Patient demographics and perioperative parameters, including the degree of hydronephrosis, urine leakage, and drainage time, were retrospectively reviewed. These data were compared with those of 30 consecutive patients who received open ureterolithotomy and intracorporeal ureteral double‐J stenting. In addition, a PubMed search was conducted and the related literature on the placement of a ureteral stent was reviewed. Twenty‐eight patients successfully underwent ureteral double‐J stenting with ureteroscopic access. No malposition of the ureteral stent was identified in the ureteroscopic group, but two patients in the intracorporeal group required postoperative adjustment of the stent. Residual stone fragments were found during stent placement in three patients in the ureteroscopic group and holmium:yttrium–aluminum–garnet laser lithotripsy was immediately performed. There was no significant difference in postoperative outcomes or complication rates between the two groups. Ureteroscope‐assisted ureteral double‐J stenting is a simple and safe alternative allowing intraluminal navigation along the entire ureter, correct stent placement, and prompt treatment of residual stone fragments, without radiation exposure. In addition, ureteral disruption and urinary extravasation may not be concerns for ureteroscopic access with continuous normal saline irrigation.

A Modified Single Mini-Incision Complete Urinary Tract Exenteration for Urothelial Carcinoma in Dialysis Patients

Objective. To present our experience with single mini-incision complete urinary tract exenteration (CUTE) for female dialysis patients suffering from urothelial carcinoma (UC). Patients and Methods. Institutional review board approval was obtained. From 2005 through 2012, 14 female dialysis patients with UC underwent single mini-incision CUTE, in combination with radical hysterectomy and bilateral salpingo-oophorectomy. All were placed in the modified dorsal lithotomy position without repositioning. An infraumbilical midline mini-incision was made. Bilateral nephroureterectomy was first performed entirely extraperitoneally, followed by radical cystectomy with removal of the uterus and ovaries transperitoneally. Results. All procedures were done successfully without major complications. The median operative time was 242.5 minutes, and estimated blood loss was 500 mL. The median time to oral intake was 2 postoperative days; the median hospital stay was 11 days. Ten patients remained cancer-free at a median follow-up of 46.5 months; six patients were confirmed as having preoperatively undetectable UC or renal cell carcinoma, even after reviewing preoperative computed tomography. Conclusions. This modified technique provides a time-saving complete urinary tract extirpation to eliminate preoperatively undetectable malignancy, reduce metachronous recurrences, and avert perioperative complications associated with pneumoperitoneum and repositioning. Good cancer control and early convalescence can mutually be achieved in experienced hands.

Adrenal Ganglioneuroma:3 Case Report

We reported 3 cases of ganglioneuroma of adrenal gland, who had no complaints obviously related to the tumor and were incidentally found in image examinations. All received surgical excision. The pathologic report was ganglioneuroma and one had a rare combination with adrenal medullary tumor. The 3 cases were presented and the literature was reviewed.