Extrarenal adult Wilms' tumor

Extrarenal Wilms' tumor is a very rare disease, occurring mostly in children. Sixteen cases have been reported in the world medical literature. A case of retroperitoneal extrarenal Wilms' tumor is reported in a 36-year old white male and the literature reviewed. Pathologic examination revealed both undifferentiated renal blastoma plus differentiated areas containing immature tubules and glomeruli. No evidence of extrarenal teratomatous tissue was seen. Theories for the histogenesis of this rare tumor are discussed.

Carcinoma of the female urethra: combined iridium Ir 192 interstitial and external beam radiotherapy

Three female patients (mean age 55) with carcinoma of the urethra were treated with combined external beam irradiation (4,000 to 5,000 rads) and interstitial irradiation with iridium Ir 192 (2,700 to 3,000 rads) applied with a modified Syed-Neblett template. Two patients are alive with no evidence of disease at 27 and 37 months. One patient died of a second primary tumor at 30 months, without histologic evidence of the original urethral neoplasm. No patient had significant complications of therapy. This treatment regimen is effective for selected women with urethral carcinoma.

Treatment of incarceration of the penis by tempered steel bushings

A case of penile incarceration secondary to a tempered steel ball bearing compromising the penile vascular supply is presented. The management of this case is described and guidelines for the management of similar cases reviewed.

Neonatal vaginal cysts: diagnosis and management

We report a 2.5 cm. vaginal cystic mass in a neonate. The differential diagnosis, evaluation and management of this lesion are discussed.

Extratesticular hemorrhage associated with torsion of the spermatic cord: sonographic demonstration

Using ultrasound (US), we studied seven patients with torsion of the spermatic cord associated with a large amount of extratesticular hemorrhage. In each case, US showed a large echogenic or complex extratesticular mass caused by the hemorrhage, in addition to a hypoechoic testis and scrotal skin thickening. This appearance should be recognized as part of the spectrum of sonographic appearances that can be seen in torsion.

Emphysematous pyelonephritis: diagnosis and treatment

Emphysematous pyelonephritis is a rare life-threatening bacterial infection usually occurring in patients with diabetes mellitus and producing gas within the renal parenchyma and/or perirenal tissue. We add four cases to the 62 previously reported in the literature. The overall mortality is 38%, with only 29% survival for those treated medically compared to 71% for those given both medical and surgical treatment. Early diagnosis with the aid of renal ultrasonography and/or computerized axial tomography and aggressive early combined medical-surgical management are emphasized.

Squamous cell carcinoma of cervix metastatic to ileal loop

A case is presented of squamous cell carcinoma of the cervix with an isolated metastasis to an ileal loop six years after diversion and seven years after definitive treatment of the primary lesion with irradiation.

Flow cytometric determinations of ploidy and proliferation patterns of adrenal neoplasms: an adjunct to histological classification

Flow cytometric deoxyribonucleic acid measurements were performed with propidium iodide on 7 adrenal neoplasms and 4 normal adrenal glands to determine how useful this technique would be in defining malignancy. The 4 cases classified histologically as carcinoma all had aneuploid stemlines of 2.7, 3.3, 3.4 and 3.6c respectively, whereas the 4 normal glands and an aldosteronoma had only a small percentage (less than 10 per cent) of hyperdiploid cells (greater than 2c) at the tetraploid level (4c). A pheochromocytoma and benign adenoma had significant tetraploid populations of 30 and 18 per cent, respectively, with no evidence of aneuploid cells. Flow cytometry determination of deoxyribonucleic acid ploidy values is an accurate, objective, quantitative mean to identify adrenal malignancy and should have a role in the pathological evaluation of adrenal neoplasms.

Flow cytometry in feminizing adrenocortical carcinoma

A case of feminizing adrenal cortical neoplasm is presented in which automated flow cytometry determination of deoxyribonucleic acid content was used to confirm malignancy.

Bilateral granulomatous orchitis: manifestation of idiopathic systemic granulomatosis

A case is reported of idiopathic systemic granulomatosis that was manifested by bilateral testicular enlargement and was misdiagnosed clinically as lymphoma. Despite high dose steroid and cyclophosphamide therapy, the patient died of disease within 9 months of diagnosis.

Spontaneous vesicoileal fistula two years post ureteroileoneocystostomy undiversion

The complication of spontaneous vesicoileal fistula formation in an eleven-year-old male two years after ureteroileoneocystostomy undiversion is presented.

Cytology of bladder papilloma

Eighty-four urinary cytology specimens from 51 patients known to have bladder papilloma were reviewed and compared with 30 specimens from patients without neoplastic urologic disease, 12 specimens from patients later found to have papillomas that were unsuspected at the time of examination and 6 specimens from patients with a history of papilloma but no present evidence of the disease. No specific findings were identified that could be used to make a cytologic diagnosis of papilloma. However, the specimens from patients with papilloma were likely to contain an increased number of exfoliated epithelial cells, including atypically shaped cells that were small and round or, less frequently, elongated; they were also likely to contain a small number of red blood cells. This combination of cytologic findings yielded a pattern that can be described as consistent with or suggestive of papilloma in the appropriate clinical setting. It is not diagnostic since the absence of this cytologic pattern does not rule out papilloma, and the same cytologic features can be found (less frequently) in patients with other urologic diseases.

Flow cytometry of ethanol-fixed versus fresh bladder barbotage specimens

Saline bladder barbotage specimens were obtained from 99 patients for comparison of flow cytometric deoxyribonucleic acid analyses using fresh versus ethanol-fixed cell preparation techniques. The analyses were consistent for the 2 methods in 87 (88 per cent) of the 99 cases (p less than 0.0001, Kappa statistic for agreement). Since accurate, reproducible results are obtainable on fixed bladder washings, samples may be sent to flow cytometry centers for analysis.

The use of ultrasound for evaluating subacute unilateral scrotal swelling

In 15 patients with subacute (longer than 8 hours) unilateral scrotal swelling in whom the etiology was in doubt scrotal ultrasound was used to determine whether the pathological condition was intratesticular and/or extratesticular. Surgical exploration confirmed intratesticular or intratesticular and extratesticular findings in 9 patients: 8 had torsion of the spermatic cord (including a testis rupture in 1 and epididymal ruptures in 2) and 1 had a mixed germ cell carcinoma. Of the 6 patients with extratesticular findings 3 had clinical epididymitis that resolved on antibiotic therapy and 2 had what appeared to be paratesticular hematomas with normal testes presumed to be secondary to minor trauma. The condition resolved with conservative therapy in the latter 2 patients. The remaining patient required surgical drainage because of the size and an epididymal rupture suspected by the ultrasound examination. Scrotal ultrasound is a quick, noninvasive, easily applied, accurate method to diagnose scrotal pathological conditions and should be used whenever the etiology of scrotal swelling is in doubt.

Intratubular malignant germ cells (carcinoma in situ) accompanying invasive testicular germ cell tumors

We examined 111 radical orchiectomy specimens from patients with germ cell tumors of the testis treated between 1971 and 1981 for the presence of intratubular malignant germ cells (so-called carcinoma in situ) in adjacent testicular tissue. Of the specimens 12 were unevaluable because the entire specimen was tumor, while 36 of 44 cases of pure seminoma (82 per cent) and 41 of 55 mixed or nonseminomatous tumors (75 per cent) had intratubular malignant germ cells. Of the 22 cases without intratubular malignant germ cells 10 had severe atypia that suggested an earlier or borderline stage of development. These data support the contention that germ cell tumors originate as intratubular neoplasms or so-called carcinoma in situ in the seminiferous tubules.

Intravesical administration of bacillus Calmette-Guérin in patients with recurrent superficial carcinoma of the urinary bladder: report of a prospective, randomized trial

In an attempt to prevent, delay, or reduce further tumor occurrence, 88 patients with recurrent, superficial carcinoma of the urinary bladder were randomly assigned to receive either standard therapy (cystoscopy with fulguration) or standard therapy and bacillus Calmette-Guérin (BCG). BCG was administered intravesically and percutaneously once weekly for 6 weeks. No serious toxicity was seen. There were 43 evaluable patients in each of the two groups. Results in the BCG group versus the control group were as follows: reduction in the number of recurrent tumors (43 vs 27 patients [P less than 0.001] ); conversion to negative cytology (11 of 33 vs three of 34 patients [P less than 0.05] ); and tumor progression requiring cystectomy (three vs 15 patients [P less than 0.001] ). Disease-free interval (P less than 0.001), time with negative cytology (P less than 0.001), and time to progression of disease (P less than 0.003) were longer in patients treated with BCG. These results indicate that the combination of standard therapy and BCG is more effective than standard therapy alone in patients with recurrent superficial bladder tumors.

Flow cytometric evaluation of sperm from patients with testicular carcinoma

Semen samples from 14 patients with testicular cancer were analyzed by new flow cytometry techniques and by conventional semen analysis. Samples were obtained post-unilateral orchiectomy and prior to further treatment. With only 1 exception, light microscopic analysis of sperm count and morphology indicated a decrease of normal sperm production and incomplete or abnormal differentiation. Flow cytometry of semen aliquots showed, with the same exception as above, increased acridine orange staining of the sperm nuclear chromatin, attributed to abnormal chromatin composition and condensation. In addition, the chromatin structure of isolated sperm nuclei was abnormally sensitive to thermal stress. These changes were present up to 15 months post orchiectomy and suggest abnormal spermiogenesis in the contralateral testis of patients with testicular tumors. Of the 14 patients studied only 1 fell well within the normal range for all parameters measured; 2 other patients were in the low normal range for all parameters and 1 patient fell below normal for light microscope derived measurements but was normal by flow cytometry. The other 10 patients had abnormal measurements for all parameters. The assessment of spermiogenesis by flow cytometry studies of sperm chromatin appears to be a sensitive and valuable new parameter of fertility that cannot be determined by conventional semen analysis.

Lymphomatoid granulomatosis masquerading as hypernephroma with lung metastases

We report a case of lymphomatoid granulomatosis, a clinicopathologic entity characterized by angiocentric, angiodestructive and lymphoreticular proliferation, which was mistaken for a classical solid renal neoplasm with lung metastases.

Extracorporeal circulation for renal cell carcinoma with supradiaphragmatic vena caval thrombi

Extension of tumor into the vena cava occurs in 5 to 10 per cent of the cases of renal cell carcinomas. Of these cases 14 to 39 per cent may extend to or into the right atrium. Acceptable techniques for dealing with this situation include cross-clamping the atrium, using positive pressure ventilation and extracting the thrombus with a Fogarty or Foley catheter, and extracorporeal circulation or a cardiopulmonary bypass with open excision of the tumor extension. Since 1974 we have seen 2 men and 2 women, mean age 56 years, with clear cell renal carcinomas and supradiaphragmatic vena caval tumor extension (1 with additional pulmonary embolism). None had other evidence of metastatic disease determined on staging evaluation by celiac and renal angiography, liver scan, bone scan and chest tomography. Each patient was explored with the planned use of extracorporeal circulation or cardiopulmonary bypass, Greenfield vena caval filter insertion and standard radical nephrectomy. Resection was not done in 1 patient with biopsy proved tumor eroding through the right atrial wall. He died of disease in 8 months. Of the remaining 3 patients who had the tumors completely resected 1 is alive with recurrent disease in the retroperitoneum at 44 months, 1 died of metastatic disease to the bones and liver at 39 months, and 1 died 1 day postoperatively of technical complications with no evidence of residual disease at autopsy. In the absence of metastatic disease it seems reasonable to pursue a radical surgical approach in patients with renal cell carcinoma and supradiaphragmatic tumor thrombus. The use of extracorporeal circulation and post-extraction insertion of the Greenfield vena caval filter offers the surgeon the advantage of direct visualization and better vascular control in removing the thrombus, as well as protection from the possibility of post-extraction pulmonary embolism. With the combined use of these techniques, the previously hopeless situation for these patients has been improved.