Murali R. Kamat

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)

Adenocarcinoma of bladder

Forty-eight patients with adenocarcinoma (21 urachal and 27 non-urachal) of the bladder were treated at the Tata Memorial Hospital between 1976 and 1992. The study group consisted of 32 men and 16 women. The urachal tumours were more common in younger patients (mean age: 49 years) than were non-urachal tumours (mean age: 58 years). The overall 5-year survival in this series was 37%. Stage and grade were powerful predictors of outcome. Patients with non-urachal tumours showed an overall survival rate of 29.9% compared with 45.7% in patients with urachal tumours (P= 0.14). Radical cystectomy was the most common treatment modality in patients with non-urachal tumours and yielded an overall 5-year survival of 35%. Patients with urachal tumours were treated with either partial cystectomy or radical cystectomy. The 5-year survival following partial cystectomy was 56.3% compared with 25.9% following a radical cystectomy and the difference between the two was not statistically significant (P = 0.76).

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.

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.

Is bladder conservation feasible? An Indian experience.

With the introduction of chemotherapy in the treatment of muscle invasive bladder cancers, endeavors at improving disease-free survival/overall survival are ongoing. As high objective response rates were seen with MVAC/CMV regimens (M-methotrexate, V-vinblastine, A-adriamycin, C-cisplatin) organ conservation is being attempted. A phase II protocol was designed using MVAC as the initial therapy. Based on the response to two cycles all patients were evaluated and where possible the bladder was preserved. Twenty-nine patients completed the protocol and had a median follow-up of 24 months. Complete response (CR) was noted in 7/29 (24.1%) of patients, while 11/29 (38%) had partial response (PR) and 11/29 (38%) showed no response (NR). Bladder conservation was possible in 15/29 (51.7%) patients initially with the use of radiation therapy after the initial chemotherapy. Ten of these patients are presently alive with their bladders intact. Three patients died of distant disease, two with normal bladders and one with local relapse. Two of the other patients required salvage cystectomy and are alive and disease-free. All complete responders 7/7 (100%) and 5/11 (45%) partial responders could have their bladders conserved. Three of 11 partial responders who refused radiotherapy and 11/11 non-responders underwent radical cystectomy after initial chemotherapy. Subset analysis indicates that low stage and grade tumours had the highest likelihood of bladder preservation, and there was no difference in overall survival in the groups according to response criteria. As our study consists of a small number of selected patients, it would be improper to draw firm conclusions. However, it seems that initial chemotherapy selects out a subset of patients with a good prognosis and the chance for bladder conservation.

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)

Extra-adrenal non-functioning paraganglioma.

Extraadrenal non-functioning retroperitoneal paragangliomas are rare tumors. We herein report a case of retroperitoneal tumor which posed a diagnostic and management problem. Review of the literature shows only 16 previously reported cases of extraadrenal paraganglioma which underwent complete surgical excision.