Peter J. Effert

Metabolic Imaging of Untreated Prostate Cancer by Positron Emission Tomography with sup 18 Fluorine-Labeled Deoxyglucose

PURPOSE We evaluated positron emission tomograph (PET) with 18fluorine (18F)-labeled deoxyglucose for metabolic grading of untreated primary prostate cancer, and differentiation of benign and malignant prostatic disease. MATERIALS AND METHODS A total of 48 patients with untreated prostate cancer of different stages and 16 with histologically confirmed benign prostatic hyperplasia (BPH) underwent static PET after intravenous injection of 150 to 300 MBq. 18F-deoxyglucose. 18F-deoxyglucose accumulation was quantitated by calculating differential uptake ratios and prostate-to-skeletal muscle ratios. RESULTS Low 18F-deoxyglucose uptake was noted in the majority of primary tumors (81%). 18F-deoxyglucose accumulation did not correlate with increasing tumor grade or stage. There was a significant overlap in uptake values in BPH and malignant prostatic disease. A trend towards statistical significance was noted with lower prostate-to-skeletal muscle ratios in patients with BPH (p < 0.07). Increased 18F-deoxyglucose accumulation was detected in some patients with BPH and malignant prostatic disease, as well as in those with lymph node and bone metastases of prostate cancer. CONCLUSIONS 18F-deoxyglucose PET does not allow for metabolic labeling in the majority of untreated primary prostate cancers. BPH and primary prostate cancer cannot be reliably differentiated on the basis of PET. Increased 18F-deoxyglucose accumulation occurs in some primary prostate tumors and in metastatic deposits of prostate cancer.

Primary Adenocarcinoma of the Seminal Vesicles

PURPOSE We provide an overview of seminal vesicle carcinoma, a rare entity that is difficult to diagnose and traditionally has been associated with a poor prognosis. MATERIALS AND METHODS A literature search for seminal vesicle carcinoma was performed, and current concepts related to the diagnosis and clinical management were reviewed. Two unpublished additional cases recently treated at our institution were added to the international experience. Special attention was given to new developments in diagnostic methods. Histopathological changes and biomarker criteria are provided to allow accurate diagnosis of this condition. RESULTS Early diagnosis of seminal vesicle carcinoma has often been difficult due to a lack of immunohistochemical markers that distinguish this entity from invasive adenocarcinoma of adjacent organs. A total of 49 documented cases of seminal vesicle carcinoma in men between 19 and 90 years old has been reported in the current literature. Two additional cases that were diagnosed and treated at our institution are incorporated into this review. Recently the tissue marker CA 125 has substantially increased the accurate diagnosis of seminal vesicle carcinoma. In addition, increased serum CA 125 in patients with this disease has been reported and serum levels correlate well with the clinical course of the disease. Radical surgery in combination with adjuvant radiotherapy or androgen deprivation has resulted in long-term palliation in some patients with advanced disease. CONCLUSIONS Including seminal vesicle carcinoma in the differential diagnosis of lower urinary tract symptoms will improve detection. Improved imaging tools and the availability of a serum marker will undoubtedly enhance detection at the earliest stages. More defined histopathological criteria will allow diagnosis even with small biopsy specimens. Radical surgery appears to offer the best chance for cure but hormonal manipulation and radiotherapy seem to be effective as adjuvant treatment modalities.

Nerve fibers in tumors of the human urinary bladder

Abstract.Exophytic tumors of the urinary bladder were examined by means of transmission electron microscopy for the presence of neural tissue because, as yet, there has been hardly any discussion of a neuronal component in the biology of neoplasms. In the stroma and rarely in the epithelium of bladder tumors, fine nerve strands were found to be irregularly distributed. These strands comprised one to a maximum of five axons containing predominantly colocalized clear and dense-core vesicles. Immunohistochemistry revealed some nerve-like structures showing vasoactive intestinal neuropeptide (VIP) reactivity. This response and the combination of vesicle types indicate that parasympathetic cholinergic neurons contribute to the innervation of the tumors. Thus, a morphological basis for neuronal influence on the behavior of such tumors has been demonstrated.

Laparoskopische Lymphadenektomie beim Prostatakarzinom Erfahrungen bei 120 Patienten

ZusammenfassungBei 120 Patienten mit klinisch organbegrenztem Prostatakarzinom wurde vor geplanter radikaler Prostatektomie oder interstitieller Strahlentherapie eine laparoskopische Lymphadenektomie durchgeführt. Durchschnittlich wurden 13 Lymphknoten reseziert, bei 21 Patienten fanden sich zwischen 1 und 9 Lymphknotenmetastasen. Mit zunehmender Erfahrung sank die Operationszeit erheblich, so daß bei radikalchirurgischem Vorgehen meist in selber Narkose eine perineale Prostatektomie angeschlossen wurde. Die totale Komplikationsrate von 10 % erscheint niedrig, nur bei 2/120 Patienten war eine offenchirurgische Revision erforderlich. Die postoperative Krankenhausverweildauer bei alleiniger Lymphadenektomie betrug durchschnittlich 2 Tage. Insbesondere Patienten mit Lymphknotenmetastasen, die nicht radikal prostatektomiert werden, sowie Patienten vor geplanter Strahlentherapie profitieren von diesem minimal invasiven Operationsverfahren. Vor radikaler perinealer Prostatektomie vermeidet das laparoskopische Lymphknotenstaging eine zusätzliche Laparotomie.SummaryLaparoscopic pelvic lymph node dissection was performed in 120 patients scheduled to undergo either radical perineal prostatectomy or radiation therapy. On average 13 lymph nodes were resected in each patient, and 21 patients were found to have metastatic disease in 1–9 lymph nodes. After an initial learning curve, mean operative time was reduced significantly, allowing laparoscopic lymph node dissection and radical prostatectomy to be performed as a one-stage procedure. The overall complication rate was 10 %; open revisions were necessary in only 2 of 120 patients. Postoperative hospital stay was 2 days in patients undergoing laparoscopic lymph node dissection only. This minimally invasive procedure is particularly beneficial to patients with lymph node metastases not undergoing radical prostatectomy, as well as to patients planned to be treated by radiation therapy. The combination of laparoscopic lymph node dissection and radical perineal prostatectomy avoids an abdominal incision and thus shortens both the hospital stay and the period of convalescence.

Invasive Potential of “Noninvasive” Human Bladder Carcinoma

In classification systems for bladder tumors, a clear distinction between superficial noninvasive and urothelial carcinoma invasive to the lamina propria is of prognostic and therapeutic significance. However, a subset of tumors classified as noninvasive is characterized by increased recurrence and progression rates. This study was done to look for ultrastructural characteristics in histopathologically noninvasive urothelial bladder carcinomas that might predict an unfavorable prognosis. In 10 (83%) of 12 bladder tumors studied extensively, electron microscopy revealed the presence of different degrees of lamina propria penetration by individual tumor cells (microlesions and microinvasions). In 10 (77%) of 13 “normal” control tissues, no such lesions or microinvasions were detected. These findings indicate that ultrastructural analysis may contribute to more precise staging of superficial bladder carcinoma. Undetected microinvasions may explain more aggressive biologic behavior in a subset of bladder tumors classified as noninvasive by conventional histopathologic assessment.

Prävention der Katheterdislokation

ZusammenfassungDie Entlastung des gestauten Harntrakts durch perkutane Nephrostomie sollte gerade in Notfallsituationen technisch einfach und möglichst komplikationsarm erfolgen. Die frühe oder verzögerte Katheterdislokation ist ein vergleichsweise häufiges Ereignis, das auch bei optimaler Positionierung des Punktionskanals nicht zuverlässig zu vermeiden ist. In diesen Fällen ist eine erneute Punktion mit entsprechender Belastung und Gefährdung des Patienten meist unumgänglich. Ziel bei der Entwicklung des hier vorgestellten modifizierten Nephrostomiekatheters war die Beibehaltung einer möglichst einfachen Punktionstechnik bei verbessertem Schutz vor Dislokation.AbstractInsertion of a percutaneous nephrostomy for decompression of the collecting system in cases of obstruction should be easy and safe to perform. Early or delayed catheter dislodgment is a more frequent event. Even with optimal positioning of the puncture site, this complication cannot be prevented reliably. Should dislodgment occur, a new puncture is necessary in most cases exposing the patient to risk and discomfort. The modified percutaneous nephrostomy tube presented here was designed for better protection against dislodgment while retaining technical ease of tube insertion.