Rainy Umbas

Correlation between Low Gleason Score and Prostate Specific Antigen Levels with Incidence of Bone Metastases in Prostate Cancer Patients: When to Omit Bone Scans?

BACKGROUND To identify correlation and incidence of bone metastases in prostate cancer patient with low Gleason scores (GS) and prostate specific antigen (PSA) levels. MATERIALS AND METHODS This descriptive restrospective study covered patients with prostate cancer in Cipto Mangunkusumo Hospital in 2006-2011. Of a total of 478, those who had PSA values, histological examination, and bone scan were included, resulting in 358 eligible cases. PSA values were measured using the sandwich electrochemiluminescent immunoassay. Histological examination was graded according to Gleasons grading system and divided into 3 categories: well differentiated (GS ≤ 6), moderately differentiated (GS 7) and poorly differentiated (GS 8-10). Bone scans were performed using a radiopharmaceutical agent (Tc 99m methylenen diphosphonate) with images captured by gamma camera. RESULTS The mean age was 67.5 ± 7.8, mean GS was 7.7 ± 1.3 and median PSA was 56.9 (range: 0.48-17000 ng/ mL). There were 11 patients (3.0%) with positive bone scan with PSA<20 ng/mL and GS<8. Furthermore, there were 2 patients (0.6%) with GS ≤ 6 and PSA<10 ng/mL showing bone metastasis. CONCLUSIONS In our study, there were still small percentage of patients with bone metastasis even when low values of PSA (PSA<10 ng/mL) and GS (GS ≤ 6) were applied.

Surgical Management of Giant Genital Condyloma Acuminata by Using Double Keystone Flaps

Condyloma acuminata in the external genitalia (genital warts) is a sexually transmitted disease that is often caused by human papillomavirus (HPV). We report a case of giant genital condyloma acuminata in a 35-year-old male patient with HIV comorbidity treated by wide surgical excision. Excision defect was covered with split thickness skin graft (STSG) and double keystone flaps. There was no complication after surgery. Ten months following surgery, there was no new condyloma lesion and the patient had normal voiding and erectile functions.

Case of perinephric abscess disguising as renal tumor

Perinephric abscess is an accumulation of pus in the perinephric space.1 It frequently occurs as a secondary event to upper tract urosepsis, usually in relation with an infective staghorn stone.1 Clinical presentation of perinephric abscess is notoriously silent. Therefore, diagnosing perinephric abscess will be difficult without the aid of imaging.2 On the other side, malignant tumors with extra renal extension, perinephric hematoma, and urinoma may appear similar to perinephric abscess on imaging studies.3 Thus, a thorough examination should be performed in diagnosing perinephric abscess. We describe an unusual case of chronic pyelonephritis with perinephric abscess in 64-year-old man diagnosed after showing non-specific clinical presentation, conflicting laboratory results and unusual imaging findings.

Recent advances in optical imaging technologies for the detection of bladder cancer

White-light cystoscopy (WLC) is the diagnostic standard for the detection of bladder cancer (BC). However, the detection of small papillary and subtle flat carcinoma in situ lesions is not always possible with WLC. Several adjunctive optical imaging technologies have been developed to improve BC detection and resection. Photodynamic diagnosis, which requires the administering of a photoactive substance, has a higher detection rate than WLC for the detection of BC. Narrow-band imaging provides better visualization of tumors by contrast enhancement between normal mucosa and well-vascularized lesions. A technology called confocal laser endomicroscopy can be used to obtain detailed images of tissue structure. Optical coherence tomography is a high-resolution imaging process that enables noninvasive, real-time, and high-quality tissue images. Several other optical imaging technologies are also being developed to assist with the detection of BC. In this review, we provide an overview of the strengths and weaknesses of these imaging technologies for the detection of BC.

Survival analysis and development of a prognostic nomogram for bone-metastatic prostate cancer patients: A single-center experience in Indonesia

To analyze predictive clinical factors of survival in bone‐metastatic prostate cancer, and to develop a prognostic nomogram for patients with this condition.

Thrombus-like Tumor of Renal Cell Carcinoma Mimicking Transitional Cell Carcinoma of Kidney: A Case Report.

Renal cell carcinoma (RCC) is the most common malignancy of the kidney. It is not commonly form tumor thrombus in the ureter or renal pelvis. A 29-year-old woman presented with asymptomatic gross hematuria. Contrast CT study revealed a tumor suspected to be a Transitional Cell Carcinoma (TCC). However, tumor thrombus was found in the renal pelvis and ureter. We performed Nephroureterectomy, bladder cuff excision, and lymph node dissection, and the tumor was diagnosed histopathologically as RCC. We report a very rare case of thrombus-like tumor of renal cell carcinoma mimicking transitional cell carcinoma of kidney.