S. Cosciani Cunico

Use of Pedicle Flap from the Labia minora for the Repair of Female Urethral Strictures

Introduction: We present the method of pedicle labial urethroplasty for urethral reconstruction in female patients treated for urethral strictures. Patients and Methods: We performed urethral reconstruction using a pedicle labial flap in 2 female patients (23 and 70 years old) for urethral stricture (posttraumatic and postinflammatory origin). We used as a patch a pedicle skin flap obtained from the labia minora. The pedicle flap is slid beneath the vulvovaginal wall, until the urethra is reached. Results: In both cases a normal micturition was obtained, and cystourethrography after 24 months showed a good urethral silhouette, without residual urine. Conclusion: The pedicle labial urethroplasty seems to be a reliable technique for the repair of urethral strictures.

The collecting duct carcinoma of the kidney: a cytogenetical study.

OBJECTIVESnThe Heidelberg classification of renal tumours identifies five histotypes of renal cancer, underlining for two of them (conventional and papillary renal cancers) a strict relation between the morphological aspect and the complement of alterations evidenced by the cytogenetic analysis of the neoplastic karyotype. Due to its low incidence, the collecting duct carcinoma (CDC) has not yet been characterized from a cytogenetic point of view. This study analyses the clinical, morphologic and cytogenetic features of the CDC observed and treated in our department.nnnMETHODSnFrom January 1995 to December 2002, among the 591 patients who underwent surgery for renal cancer, we observed 11 cases of CDC (prevalence 1.9%) treated either by radical (9 cases) or partial nephrectomy (2 cases). During radical nephrectomy a loco-regional lymphadenectomy was always performed. In the 9 cases observed after 1997, a complete cytogenetic analysis of the neoplastic karyotype was carried out.nnnRESULTSnAt pathological examination the disease was found to be confined to the renal capsule (TNM 1997 stage 1) in only 3 patients; venous neoplastic trombosis and nodal metastasis were present in 3 and 6 cases respectively; 2 patients showed distant metastases (lung, bone). Two of the patients affected with stage 1 tumours are still alive with no evidence of the disease at 48 and 88 months after surgery, while the third died following the systemic progression of a concomitant bladder carcinoma. One patient with stage 4 tumour (no. 11) is alive, but the follow up time is still limited (2 months). All the other 7 patients are dead after a mean survival time of 16.3 months (range 0-45). As for cytogenetic analysis, 2 CDCs didnt grow in culture and in one case no karyotype alterations were reported. In the remaining 6 cases hypodiploid stemlines and a homogeneous chromosome alteration pattern were observed, with multiple numerical and structural aberrations (mean 11.1, range 7-15) and the continuous involvement of chromosomes 1 and X or Y, both as traslocation and deletion/monosomy. Additional abnormalities of chromosomes 22 and 13 were found to be common but less frequent.nnnCONCLUSIONSnThe clinical behaviour of the CDC is aggressive and its prognosis is surely poor; surgical treatment seems to be curative only for organ-confined cancer, accounting for the minority of cases. This neoplasm is cytogenetically characterized by hypodiploid stemlines with common involvement of chromosome 1 and the autosomes.

Gene expression profile of prostate cancer cell lines: Effect of nerve growth factor treatment

A dysregulation of the nerve growth factor (NGF)-mediated control of prostate cell growth is associated with the malignant progression of prostate epithelial cells. Exogenous NGF induced in prostate cancer (PCa) cell lines DU145 and PC3 the expression of p75(NGFR), accompanied by a reduction of the cell malignancy. The aim of this study was to analyze the profile of NGF-regulated genes the PCa cell line DU145 by using the cDNA microarray technique. NGF treatment of DU145 cells decreased the expression of 52 known genes, while the expression of 40 known genes was increased. NGF treatment of the DU145 cell line modified the expression profile of clusters of genes involved in invasion and metastasis, in cell proliferation and apoptosis, inflammation, cell metabolism and transcriptional activity. Interestingly, NGF induced the same pattern of gene modifications in both PCa cell lines. Data presented here may help to identify gene/proteins that dispose to PCa progression and to assess future markers that could allow the development of new clinic diagnostic and therapeutical approaches.

Cancer in Kidney Transplantation

Cancer in the transplanted kidney is rare, and its clinical and surgical management can be controversial. We report 3 cases of cancer in renal transplantation (1 case of renal cell carcinoma and 2 cases of transitional cell carcinoma) and their treatment. Our data and those reported in the literature suggest that these cancers can be treated like a neoplasm in the general population. However, a higher number of cases and longer follow-up periods are necessary to confirm our findings.

Renal cell carcinoma associated with incidental presentation of renal artery aneurysm: surgical management

The Renal Artery Aneurysm (RAA) is a relatively uncommon vascular lesion. A renal artery disease coexisting in patients with Renal Cell Carcinoma (RCC) is an even more infrequent clinical presentation. We reported on the treatment of a rare case of incidentally intraoperative renal artery aneurysm discovered during a nephron-sparing surgery for RCC. After the surgery the patient did not need hypertension therapy any longer. This event is well-known, in fact a number of possible contributions to a renin-mediated hypertension management has been postulated.

926 Role of F18-FDG-PET/CT in restaging patients affected by renal carcinoma

BACKGROUND: Renal cancers account for around 3% of all cancers and the most common type of (90%) is renal cell carcinoma Five-year survival rate in renal cancer patients is 68.4%. AIM: The aim of our study was to establish the role of F18-FDG-PET/CT in restaging patients with renal carcinoma who underwent partial or radical nephrectomy. Secondary aim of the study was to identify histological characteristics of the primary tumour that may be responsible for the metabolic behaviour of neoplastic lesions. MATERIALS AND METHODS: We retrospectively evaluated 68 patients with renal carcinoma in whom F18-FDG-PET/CT was performed. RESULTS: Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of F18-FDG PET/CT were 82%, 100%, 100%, 66.7% and 86.8%, respectively. CONCLUSIONS: The results of our study suggest that F18-FDG PET/CT is characterised by high specificity and positive predictive value and can be useful in restaging patients affected by

Immunity and cancer: the role of PSA IgM Immune complexes for prostate cancer

Immunoediting is a new concept in cancer surveillance. Immunity is involved in detecting cellular waste, and taking off transformed cells. In particular, natural IgM antibodies play an important role in immunosurveillance mechanisms against transformed cells in humans.? Scientific evidence indicates that biomarkers for different types of cancer, such as liver and colorectal cancer, circulate in blood associated with immunoglobulin M (IgM) to form complexes that improve diagnosis in comparison to circulating free biomarkers. In prostate cancer it has been demonstrated that testing for serum levels of the PSA-IgM immune complex improves the diagnostic performance of total PSA. Preliminary reports indicate that the combination of PSA-IgM with total PSA is the best approach to reduce the number of negative prostatic mapping thus improving the diagnosis of prostate cancer.

Which Technical Aspects have an Impact on Perceived Pain during Transperineal Prostate Biopsy? A Prospective Study Involving 445 Cases: Reducing Pain During Transperineal Prostatic Biopsy

To assess the technical aspects determining the perceived pain during prostate biopsy via transperineal access. Materials and Methods We conducted prostate biopsy with transperineal access in local anesthesia. Between January 2007 and January 2008, data on prostatic biopsies were prospectively surveyed. The patient was requested to assess perceived pain by means of a Visual Analogue Scale ranging from 0 (no pain) to 10 (unbearable pain). Complications were recorded by telephone interviews 30 days after the biopsy. The histological diagnosis was recorded. Results 445 prostate biopsies were conducted. The average perceived pain score amounted to 2.60. At univariate analysis, a lower score was recorded in cases where the anesthetic agent was diluted with physiological saline, those in which a single cutaneous access was chosen along the middle line, those in the first bioptic series as compared to the following series and those in which no sampling involved the transition region. However, the multivariate analysis showed that only the single cutaneous access was statistically significant. In those cases, also the rates of delayed perineal pain were significantly lower. The cancer diagnosis rate showed no correlations with the type of cutaneous access. Conclusions A single median cutaneous access reduces the pain associated to transperineal prostatic biopsy.

Aminolevulinic acid in diagnosis and treatment of bladder urothelial carcinoma

It might be difficult to diagnose either bladders flat lesions, such as CIS, or small papillary lesions using white-light endoscopy.Neoplastic cells can be differentiate from the normal bladder mucous membrane by using Hexyl-ALA. Hexyl aminolevulinate produces protoporphyrins overstock inside cancer cells causing a clearly visible red fluorescence when these are hit by a predetermined wavelenght light. The purpose of this study is to evaluate effectiveness of PDD (photodynamic diagnosis) by using Hexyl-ALA to identify and treat bladders surface cancer.This study considers 39 patients (33 men and 6 women) from November 2008 to January 2009. On these patients were taken, previous filling of their bladders with hexyl aminolevulinate solution, 106 hystological samples (among these: 38 were first step diagnosis, 15 were a second look and 53 were taken for a relapse suspect). The 72.6% of these samples (77) were positive for cancer, while the 27,4% (29) was normal.Of those 77 samples, 30 were discovered to b...

Surgery for renal carcinoma metastases

During the last few years, the increasing use of diagnostic imaging (especially ultrasound) has allowed a remarkable rise in the detection of asymptomatic, early-stage renal neoplasms, possibly treatable by radical surgery. Renal cell carcinoma, however, is still the renal neoplastic condition with the highest mortality rate, due in most cases to the presence of distal metastases. Because of a lack of agreement on an efficient systemic therapeutic approach, surgery is generally considered to be the most suitable option to remove metastases: it is technically easy to perform, it can increase survival and the patients psychological compliance, though metastasectomy is unlikely to cure the metastatic patient. In our experience, we studied 1475 patients who underwent surgery for renal cell carcinoma from 1983 on. 304 (20%) developed a metastasis; 4 subjects only (5.4%) out of the 74 having multiple metastatic anatomical sites were long-surviving. 39 subjects (16.9%) out of the 230 having single-site metastases are currently disease-free (mean follow-up: 80 months from diagnosis): 33 out of the 111 patients who underwent metastasectomy, 4 out of the 57 who received a medical therapy, 1 out of the 14 being administered radiotherapy, and 1 out of the 48 who were cared under palliative purposes only. Therefore we concluded that, in case of single-site (lung or adrenal) metastases, surgery is the most suitable and advisable therapeutic approach, being the only option able to achieve survival even for a small amount of patients. New biologic drugs are currently under investigation, which can interfere with tumor proliferation and angiogenesis: the study results are still preliminary, nevertheless these drugs open the way to a multimodal medical option of treatment for metastatic renal cell carcinoma.