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Periasamy K, Dey T, Goyal S, Madan R, Kumar S, Devana SK, Elumalai T, Giridhar P, Ghoshal S, Kapoor R, Das CK. Primary renal leiomyosarcoma in adult patients: a systematic review and individual patient data analysis. AFRICAN JOURNAL OF UROLOGY 2024; 30:15. [DOI: 10.1186/s12301-024-00418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 03/04/2024] [Indexed: 09/05/2024] Open
Abstract
Abstract
Purpose
The optimal management of primary renal leiomyosarcomas is unknown owing to its rarity and minimal available information about their primary, adjuvant treatment and clinical outcomes. This study systematically reviews treatment evidence and effects in terms of survival for leiomyosarcomas arising primarily from kidney, renal pelvis and renal vessels.
Method
PubMed and Embase databases were searched from inception to March 2023, with manual searches of reference lists. Two investigators independently reviewed the studies reporting management and survival outcomes of renal leiomyosarcomas.
Results
A total of 85 publications met inclusion criteria, reporting on 188 cases. The median age was 55.5 years, predominantly female [52.7%]. Pain was the most common presenting symptom [41.5%], and most tumors were high grade [45.8%]. Complete surgical resection with negative margins forms definitive treatment. The median disease-free survival and overall survival (OS) for all reviewed patients were 24 months [95%CI 4.1–43.9] and 42 months [95%CI 32.5–51.4], respectively. The OS of 1 year, 2 year, 3 year and 5 year was 78.8%, 64.4%, 53.8% and 38.9%, respectively. On univariate analysis, favorable factors for OS included tumor size ≤ 5 cm, low-grade histology, tumors of renal vascular origin and non-metastatic disease at presentation. Neoadjuvant or adjuvant treatment with either radiotherapy or chemotherapy has been shown to improve OS (NR vs. 36 months, p < 0.001), especially for high-grade tumors > 5 cm in size.
Conclusion
Radical nephrectomy with en bloc tumor resection with negative margins forms the mainstay of treatment for renal leiomyosarcomas. Adjuvant radiotherapy or chemotherapy appears to improve OS. To validate this treatment strategy, prospective multicentric efforts are required to acquire reliable data from randomized trials.
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Nitta S, Kandori S, Kojo K, Suzuki S, Hamada K, Chihara I, Shiga M, Sakka S, Nagumo Y, Kimura T, Mathis BJ, Negoro H, Okuyama A, Higashi T, Nishiyama H. Adult genitourinary sarcoma: analysis using hospital-based cancer registry data in Japan. BMC Cancer 2024; 24:215. [PMID: 38360621 PMCID: PMC10870526 DOI: 10.1186/s12885-024-11952-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/04/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Genitourinary sarcomas are rare in adults and few large-scale studies on adult genitourinary sarcoma are reported. We aimed to elucidate the clinical characteristics, survival outcomes, and prognostic factors for overall survival of adult genitourinary sarcoma in Japan. METHODS A hospital-based cancer registry data in Japan was used to identify and enroll patients diagnosed with genitourinary sarcoma in 2013. The datasets were registered from 121 institutions. RESULTS A total of 116 men and 39 women were included, with a median age of 66 years. The most common primary site was the kidney in 47 patients, followed by the paratestis in 36 patients. The most common histological type was liposarcoma in 54 patients, followed by leiomyosarcoma in 25 patients. The 5-year overall survival rates were 57.6%. On univariate analysis, male gender, paratestis as primary organ, and histological subtype of liposarcoma were predictive of favorable survival while primary kidney, bladder, or prostate gland location were predictive of unfavorable survival. On multivariate analysis, primary paratestis was an independent predictor of favorable survival while primary kidney, bladder, or prostate gland were independent predictors of unfavorable survival. CONCLUSIONS This is the first report showing the clinical characteristics and survival outcomes of adult genitourinary sarcoma in Japan using a real-world large cohort database.
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Affiliation(s)
- Satoshi Nitta
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Shuya Kandori
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan.
| | - Kosuke Kojo
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Shuhei Suzuki
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Kazuki Hamada
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Ichiro Chihara
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Masanobu Shiga
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Shotaro Sakka
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Yoshiyuki Nagumo
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Tomokazu Kimura
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Bryan J Mathis
- International Medical Center, University of Tsukuba Affiliated Hospital, 2-1-1, Amakubo, 305-8576, Tsukuba, Ibaraki, Japan
| | - Hiromitsu Negoro
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
| | - Ayako Okuyama
- Graduate School of Nursing, St Luke's International University, 10-1, Akashi, Chuo-ku, 104-0044, Tokyo, Japan
| | - Takahiro Higashi
- Institute for Cancer Control, National Cancer Center Japan, 5-1-1, Tsukiji, Chuo-ku, 104- 0045, Tokyo, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, 305-8575, Tsukuba, Ibaraki, Japan
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3
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Colecchia M, Pini GM, Pruneri G, Nicolai N, Servillo S. Soft tissue tumours of the penis. The 30-year Istituto Nazionale Tumori di Milano experience. Pathologica 2024; 116:46-54. [PMID: 38482674 PMCID: PMC10938274 DOI: 10.32074/1591-951x-953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 03/17/2024] Open
Abstract
Objective Small series and individual cases of penile soft tissue tumours are reported in the literature: these are rare tumours that represent less than 5% of all penile tumours. Methods Penile soft tissue tumours were collected from the archive of the Department of Pathology at the Istituto Nazionale dei Tumori of Milan between January 1990 and October 2021. All available medical records were retrieved and reviewed to obtain clinical information. Results Our series refers to the 30-year experience of highlighting the heterogeneity in the presentation and microscopic features of these rare sarcomas. 18 penile soft tissue tumours are described, 4 benign and 14 malignant. The mean age at diagnosis was 58.2 years (range 24-96 years) and 53.6 years among malignancies (range 24-89). The most frequent histotype was Kaposi's sarcoma (nr = 4) and very unusual histotypes were observed, namely low-grade fibromyxoid sarcoma, synovial sarcoma, proximal type epithelioid sarcoma and the first reported case of dedifferentiated liposarcoma of the penis. Conclusions Among sarcomas of the genitourinary tract, tumours of the soft tissues of the penis are the rarest. Penile sarcomas can present at a young age. Kaposi's sarcoma in HIV-negative patients has a favorable outcome, while deep sarcomas have an aggressive behavior and poor prognosis.
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Affiliation(s)
- Maurizio Colecchia
- IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giacomo Maria Pini
- Department of Pathology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giancarlo Pruneri
- Department of Pathology and Laboratory Medicine, Foundation IRCCS National Cancer Institute, Milan, Italy
- Department of Oncology and Hematoncology, University of Milan, Milan, Italy
| | - Nicola Nicolai
- Urology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sascia Servillo
- Pathology Unit, Azienda Ospedaliera di Bergamo, Bergamo, Italy
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Wang B, Xu L, Fang M, Zheng B, Yan W. Establishment of a staging system for visceral sarcoma. Cancer Med 2024; 13:e6791. [PMID: 38102873 PMCID: PMC10807571 DOI: 10.1002/cam4.6791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/22/2023] [Accepted: 11/23/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Visceral sarcoma is a rare malignancy with a poor prognosis. However, there is no recommended prognostic staging system for the malignant disease. METHOD We analyzed the data of patients diagnosed with primary soft tissue sarcoma (STS) of the abdomen and thoracic visceral organs between 2006 and 2017 at our hospital. Prognostic factors (size, tumor grade, and lymph node metastasis) were analyzed in our cohort (n = 203) and the SEER validation cohort (n = 5826). RESULTS Tumor size, grade, and lymph node metastasis were important prognostic factors for visceral sarcoma in both our and the SEER cohorts. Based on these prognostic factors, we established a new staging system for visceral sarcoma, by which patients could be stratified into clinically meaningful and non-overlapping stages in both our cohort and the SEER validation series. Moreover, the area under the curve (AUC) value of the staging system for 5-year survival was 0.84 (95% CI: 0.78-0.89) in our series and 0.80 (95% CI: 0.79-0.81) in SEER series, respectively. In addition, compared with the widely used FIGO staging system for female genital sarcoma, the visceral sarcoma staging system could more effectively and reliably stratify patients into four different prognostic groups. CONCLUSIONS The visceral sarcoma staging system is applicable for STS of the abdomen and thoracic visceral organs and is better than the current FIGO staging system for female genital sarcoma and should be incorporated into the AJCC Cancer Staging Manual.
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Affiliation(s)
- Bingnan Wang
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Lun Xu
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Meng Fang
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Biqiang Zheng
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Wangjun Yan
- Department of Musculoskeletal OncologyFudan University Shanghai Cancer CenterShanghaiChina
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
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5
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Madiraju S, Nkansah-Amankra K, Buck B, Petros FG. Muscle-invasive angiosarcoma of the urinary bladder: Case report. Urol Case Rep 2023; 51:102593. [PMID: 37886347 PMCID: PMC10598485 DOI: 10.1016/j.eucr.2023.102593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
A 71-year-old male with benign prostatic hyperplasia managed by self-catheterization presented with gross hematuria. A CT scan of abdomen and pelvis demonstrated abnormal bladder appearance with right sided mass and a diverticulum. Patient underwent transurethral resection of bladder tumor. Pathology was significant for high-grade muscle-invasive angiosarcoma. The malignant cells showed positive staining for vimentin and CD31. Given patient's underlying comorbidities and following multidisciplinary discussion, hospice care was pursued. The aim of this case report is to provide an overview on clinical presentation, diagnosis, and current management of this rare entity of genitourinary sarcoma.
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Affiliation(s)
- Srigita Madiraju
- Department of Urology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Kwabena Nkansah-Amankra
- Department of Urology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
| | - Bradley Buck
- Mercy Health – St. Vincent Medical Center, Toledo, OH, USA
| | - Firas G. Petros
- Department of Urology, College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA
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Scheiderer AN, Bahrami A, Master VA, Osunkoya AO. A Contemporary Clinicopathologic Analysis of Primary Sarcomas of the Perinephric Soft Tissue and Hilar Vessels Including a Subset Secondarily Involving the Kidney. Int J Surg Pathol 2023; 31:1179-1186. [PMID: 36437683 DOI: 10.1177/10668969221133356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
A variety of primary malignant mesenchymal neoplasms can arise from the perinephric soft tissue and hilar vessels and potentially involve the kidney, mimicking primary renal tumors. A search was made at our institution for patients that underwent radical nephrectomy with associated perinephric or hilar sarcomas from 2010 to 2021. Twenty-six patients were identified. Mean patient age was 60 years (range: 34-83 years), with 16 (62%) females and 10 (38%) males. The mean tumor size was 21.6 cm (range: 8.1-36.5 cm). Among the perinephric/retroperitoneal sarcomas, 14/20 (70%) were dedifferentiated liposarcoma, 4/20 (20%) were well-differentiated liposarcoma, and 2/20 (10%) were leiomyosarcoma. There were 4 grade 1 (20%; all well-differentiated liposarcoma), 9 grade 2 (45%), and 7 grade 3 (35%) tumors. All 6 sarcomas arising from the renal vein/inferior vena cava were leiomyosarcoma: grade 2 in 1 (17%), grade 3 in 4 (67%), and ungraded (due to neoadjuvant therapy effect) in 1 (17%) patient. Four of the 26 (15%) tumors involved the ipsilateral kidney. All 4 tumors were grade 3 sarcomas. On follow-up, 8/26 (31%) patients developed local recurrence and/or metastasis. The mean time for recurrence was 22 months (range: 7-48 months). Two patients progressed with metastasis to the lungs, both of which were grade 3 leiomyosarcoma, and appeared 11 months after the initial diagnosis. Our data suggest that while local recurrence is prevalent with most subtypes of perinephric sarcomas, high-grade leiomyosarcoma has a distinct proclivity for distant metastasis, with the lungs being the most common site.
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Affiliation(s)
- Ashley N Scheiderer
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
| | - Armita Bahrami
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Viraj A Master
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
| | - Adeboye O Osunkoya
- Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
- Department of Urology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Pathology, Veterans Affairs Medical Center, Decatur, GA, USA
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7
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Hua R, Zhao L, Xu L, Sun J, Huang J, Hua Q. Recurrent paratesticular giant liposarcoma: A case report and literature review. Front Surg 2023; 10:1171952. [PMID: 37181598 PMCID: PMC10172677 DOI: 10.3389/fsurg.2023.1171952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/31/2023] [Indexed: 05/16/2023] Open
Abstract
Background Primary paratesticular liposarcoma is rarely diagnosed among urinary tumors. In this study, through the retrospective analysis of clinical data and literature review, a case of recurrent paratesticular liposarcoma with lymph node metastasis after radical resection has been reported to explore novel strategies for the diagnosis, treatment and prognosis of this rare disease. Case summary The present case involved a patient who was misdiagnosed as a left inguinal hernia for the first time two years ago, but was later diagnosed as mixed liposarcoma by using postoperative pathology. Currently, he is readmitted to the hospital with a recurrence of the left scrotal mass for more than 1 year. Combined with the patient's past medical history, we performed radical resection of the left inguinal and scrotal tumors and lymphadenectomy of left femoral vein. The postoperative pathology indicated that well-differentiated liposarcoma was accompanied by mucinous liposarcoma (about 20%), and lymph node metastasis of left femoral vein both of which occurred at the same time. After the operation, we recommended the patient to receive further radiation therapy, but the patient and his family refused, hence we followed up the patient closely for a long time. During the recent follow-up, the patient reported no complaints of discomfort, and no recurrence of mass in the left scrotum and groin area. Conclusion After conducting extensive review of literature, we conclude that radical resection remains the key to treat primary paratesticular liposarcoma, while the significance of the lymph node metastasis is still unclear. The potential effects of postoperative adjuvant therapy depends on the pathological type, and hence close follow-up observation is essential.
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Affiliation(s)
- Runmiao Hua
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Liwei Zhao
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Li Xu
- Department of Urology, School of Medicine, Hangzhou Normal University, Hangzhou, China
| | - Ji Sun
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Jiaguo Huang
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
| | - Qiyan Hua
- Department of Urology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, China
- Correspondence: Qiyan Hua
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8
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Rachapudi S, Srinivasan A, Gorman B, Wilhelm AB, Eyzaguirre E, Orihuela E. Ewing's sarcoma of the male external genitalia: a case report and review of the literature. BMC Urol 2022; 22:121. [PMID: 35941637 PMCID: PMC9358798 DOI: 10.1186/s12894-022-01072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ewing's sarcoma (ES) within the genitourinary tract are relatively unheard of and those within the external male genitalia are even rarer. To our knowledge, this is the first known case of primary ES within the paratesticular region in an adult. CASE PRESENTATION We present a case of a 24-year-old man with a right sided testicular mass on examination that was initially characterized as an adenomatoid tumor on ultrasound. After the patient was lost to follow up over the course of 9 months, the testicular mass grew significantly and was excised with pathology revealing primary paratesticular Ewing's sarcoma. This rare case emphasizes the importance of elucidating between the broad differentials of paratesticular masses, including the rare presentation of primary ES and adds a review of the literature of ES in the external male genitalia. CONCLUSIONS Rare differentials such as this case should be considered in patients with paratesticular masses. Further diagnostic and management algorithms for extraosseous Ewing Sarcoma, particularly in the adult population, are warranted.
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Affiliation(s)
- Sruti Rachapudi
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Aditya Srinivasan
- Division of Urology, Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA.
| | - Brendan Gorman
- Division of Urology, Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
| | - Alyeesha B Wilhelm
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Eduardo Eyzaguirre
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Eduardo Orihuela
- Division of Urology, Department of Surgery, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, USA
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9
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Reimers MA, Sehn JK, Van Tine BA, Smith ZL. Primary Prostatic Synovial Sarcoma With Pulmonary Metastases Identified by Routine Next-Generation Sequencing. JCO Precis Oncol 2022; 5:1133-1140. [PMID: 34994631 DOI: 10.1200/po.21.00051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Melissa A Reimers
- Division of Oncology, Department of Internal Medicine, Section of Medical Oncology, Washington University in St Louis, St Louis, MO.,Siteman Cancer Center, Washington University in St Louis, St Louis, MO
| | - Jennifer K Sehn
- Department of Pathology and Immunology, Washington University in St Louis, St Louis, MO
| | - Brian A Van Tine
- Division of Oncology, Department of Internal Medicine, Section of Medical Oncology, Washington University in St Louis, St Louis, MO.,Siteman Cancer Center, Washington University in St Louis, St Louis, MO.,Department of Pediatric Hematology and Oncology, St Louis Children's Hospital, St Louis, MO
| | - Zachary L Smith
- Siteman Cancer Center, Washington University in St Louis, St Louis, MO.,Division of Urologic Surgery, Department of Surgery, Washington University in St Louis, St Louis, MO
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10
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Kamitani R, Matsumoto K, Takeda T, Mizuno R, Oya M. Optimal surgical treatment for paratesticular leiomyosarcoma: retrospective analysis of 217 reported cases. BMC Cancer 2022; 22:15. [PMID: 34980039 PMCID: PMC8722180 DOI: 10.1186/s12885-021-09122-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Paratesticular leiomyosarcoma (LMS) is a rare tumor. Conventionally, tumor resection by high inguinal orchiectomy is performed as the preferred treatment approach for paratesticular sarcoma. On the other hand, testis-sparing surgery has recently attracted attention as a less-invasive treatment option for paratesticular sarcoma. However, the prognostic predictors and optimal treatment strategy for paratesticular LMS remain unclear because of its rarity. In this study, we systematically reviewed previously reported cases of paratesticular LMS to evaluate the prognostic factors and establish the optimal treatment strategy. METHODS A systematic search of Medline, Web of Science, Embase, and Google was performed to find articles describing localized paratesticular LMS published between 1971 and 2020 in English. The final cohort included 217 patients in 167 articles. The starting point of this study was the time of definitive surgical treatment, and the end point was the time of local recurrence (LR), distant metastasis (DM), and disease-specific mortality. RESULTS Patients with cutaneous LMS had a slightly better LR-free survival, DM-free survival, and disease-specific survival than those with subcutaneous LMS (p = 0.745, p = 0.033, and p = 0.126, respectively). Patients with higher grade tumors had a significantly higher risk of DM and disease-specific mortality (Grade 3 vs Grade 1 p < 0.001, and Grade 3 vs Grade 1 p < 0.001, respectively). In addition, those with a microscopic positive margin had a significantly higher risk of LR and DM than those with a negative margin (p < 0.001, and p = 0.018, respectively). Patients who underwent simple tumorectomy had a slightly higher risk of LR than those who underwent high inguinal orchiectomy (p = 0.067). Subgroup analysis of cutaneous LMS demonstrated that the difference in LR between simple tumorectomy and high inguinal orchiectomy was limited (p = 0.212). On the other hand, subgroup analysis of subcutaneous LMS revealed a significant difference in LR (p = 0.039). CONCLUSIONS Our study demonstrated that subcutaneous LMS and high-grade tumors are prognostic factors for paratesticular LMS. For subcutaneous LMS, tumorectomy with high inguinal orchiectomy should be the optimal treatment strategy to achieve a negative surgical margin.
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Affiliation(s)
- Rei Kamitani
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
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11
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Wu R, Liu X, Song Y, Yi S, Chen W, Fu W, Zhu J. Spontaneous Rupture of Rhabdomyosarcoma of the Testis With Unilateral Ptosis: A Case Report and Literature Review. Front Pediatr 2022; 10:904275. [PMID: 35837241 PMCID: PMC9273775 DOI: 10.3389/fped.2022.904275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Spontaneous rupture of testicular rhabdomyosarcoma is very rare. We report a case of spontaneous testicular rupture that was pathologically confirmed as rhabdomyosarcoma with unilateral blepharoptosis. The patient, a 19-year-old male, and his father had weakness of the left eyelid muscle. The patient was suspected to have a right inguinal hernia by a family doctor but was not treated further. 2 days later, there was skin itching in the right inguinal area, accompanied by redness, swelling and discomfort of the right scrotum, and the patient went to the local hospital again. Ultrasound examination showed that a contusion of the right testis may have been complicated with orchitis. Oral levofloxacin was ineffective. In addition, the swelling of scrotal increased significantly. He came to the emergency room of our hospital and also was treated with levofloxacin, but the pain was still not relieved. CT and ultrasound examination could not identify the cause of the disease. Exploration of the right scrotum was performed under general anesthesia and confirmed that the right testis had spontaneously ruptured. The pathological diagnosis was rhabdomyosarcoma of the right testis. Testicular rhabdomyosarcoma is clinically rare, and spontaneous rupture is even rarer. The pathogenesis of the disease needs to be further studied, and the diagnosis should be made on a case-by-case basis. Overall, the prognosis of testicular rhabdomyosarcoma is poor. As seen in this case, further study is required to determine whether there is some association between testicular rhabdomyosarcoma and ptosis. Unfortunately, the patient's family rejected a genetic examination because of financial difficulty. We only report a single case of this rare phenomenon here.
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Affiliation(s)
- Ronghua Wu
- Department of Urology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Xing Liu
- Department of Urology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Yajun Song
- Department of Urology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Shanhong Yi
- Department of Urology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Wei Chen
- Department of Urology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Wanlei Fu
- Department of Pathology, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Jingzhen Zhu
- Department of Urology, Xinqiao Hospital of Army Medical University, Chongqing, China
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12
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Wenzel M, Siron N, Collà Ruvolo C, Nocera L, Würnschimmel C, Tian Z, Shariat SF, Saad F, Briganti A, Tilki D, Banek S, Kluth LA, Roos FC, Chun FKH, Karakiewicz PI. Temporal trends, tumor characteristics and stage-specific survival in penile non-squamous cell carcinoma vs. squamous cell carcinoma. Cancer Causes Control 2021; 33:25-35. [PMID: 34476653 PMCID: PMC8738356 DOI: 10.1007/s10552-021-01493-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/24/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare Cancer-specific mortality (CSM) in patients with Squamous cell carcinoma (SCC) vs. non-SCC penile cancer, since survival outcomes may differ between histological subtypes. METHODS Within the Surveillance, Epidemiology and End Results database (2004-2016), penile cancer patients of all stages were identified. Temporal trend analyses, cumulative incidence and Kaplan-Meier plots, multivariable Cox regression and Fine and Gray competing-risks regression analyses tested for CSM differences between non-SCC vs. SCC penile cancer patients. RESULTS Of 4,120 eligible penile cancer patients, 123 (3%) harbored non-SCC vs. 4,027 (97%) SCC. Of all non-SCC patients, 51 (41%) harbored melanomas, 42 (34%) basal cell carcinomas, 10 (8%) adenocarcinomas, eight (6.5%) skin appendage malignancies, six (5%) epithelial cell neoplasms, two (1.5%) neuroendocrine tumors, two (1.5%) lymphomas, two (1.5%) sarcomas. Stage at presentation differed between non-SCC vs. SCC. In temporal trend analyses, non-SCC diagnoses neither decreased nor increased over time (p > 0.05). After stratification according to localized, locally advanced, and metastatic stage, no CSM differences were observed between non-SCC vs. SCC, with 5-year survival rates of 11 vs 11% (p = 0.9) for localized, 33 vs. 37% (p = 0.4) for locally advanced, and 1-year survival rates of 37 vs. 53% (p = 0.9) for metastatic penile cancer, respectively. After propensity score matching for patient and tumor characteristics and additional multivariable adjustment, no CSM differences between non-SCC vs. SCC were observed. CONCLUSION Non-SCC penile cancer is rare. Although exceptions exist, on average, non-SCC penile cancer has comparable CSM as SCC penile cancer patients, after stratification for localized, locally invasive, and metastatic disease.
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Affiliation(s)
- Mike Wenzel
- Division of Urology, Cancer Prognostictables and Health Outcomes Unit, University of Montréal Health Center, Montreal, QC, Canada.
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Theodor- Stern Kai 7, 60590, Frankfurt am Main, Germany.
| | - Nicolas Siron
- Division of Urology, Cancer Prognostictables and Health Outcomes Unit, University of Montréal Health Center, Montreal, QC, Canada
| | - Claudia Collà Ruvolo
- Division of Urology, Cancer Prognostictables and Health Outcomes Unit, University of Montréal Health Center, Montreal, QC, Canada
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Luigi Nocera
- Division of Urology, Cancer Prognostictables and Health Outcomes Unit, University of Montréal Health Center, Montreal, QC, Canada
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Christoph Würnschimmel
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Zhe Tian
- Division of Urology, Cancer Prognostictables and Health Outcomes Unit, University of Montréal Health Center, Montreal, QC, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Departments of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prag, Czech Republic
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Fred Saad
- Division of Urology, Cancer Prognostictables and Health Outcomes Unit, University of Montréal Health Center, Montreal, QC, Canada
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Severine Banek
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Theodor- Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Theodor- Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Frederik C Roos
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Theodor- Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt, Theodor- Stern Kai 7, 60590, Frankfurt am Main, Germany
| | - Pierre I Karakiewicz
- Division of Urology, Cancer Prognostictables and Health Outcomes Unit, University of Montréal Health Center, Montreal, QC, Canada
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Gupta A, Kulshrestha R, Kishore K, Micke O, Kumar R, Garg K, Sharma D, Pandey R. Identifying Patterns of Failure and Risk Factors for Recurrence in Patients of Paratesticular Sarcomas: Protocol of a Systematic Review and Meta-Analysis. Int J Surg Protoc 2021; 25:84-91. [PMID: 34113745 PMCID: PMC8162288 DOI: 10.29337/ijsp.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Para testicular sarcomas are rare mesenchymal tumors that affect patients of all ages. Unlike other sites of sarcoma, they tend to be of lower grade and have a higher propensity for lymphatic spread. Management is hampered by the small number of patients who differ in terms of tumor grade and histology. Current treatment approaches are based on case reports, small case series and literature reviews, resulting in a number of unresolved issues. The consensus on the type of surgery and adjuvant treatment is yet to be determined. The local relapse rates in the scrotum and groin after orchidectomy comes out to be 25%–37%, indicating the need for either aggressive surgery or adjuvant treatment. There is a paucity of data identifying the patterns of failure and risk factors for recurrence, which will help clinicians tailor appropriate treatment. Methods: We aim to perform a systematic review and meta-analysis of the available data in the last 50 years in a methodologically rigorous and transparent manner to identify patterns of failure and high-risk factors for recurrence. The protocol is prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA-P) 2015 guidelines. The protocol is registered in the International Prospective Register of Systematic Reviews (CRD42021237134). Highlights Para testicular sarcomas are rare mesenchymal tumors that affects patients of all ages. Current treatment approaches are based on case reports, small case series and literature reviews, resulting in a number of unresolved issues. A systemic review was performed in 2013 based on survival rates, prognostic factors, and relapse sites on paratesticular sarcomas. However, it lacks a comprehensive review that can guide radiation oncologists to select in which patient’s postoperative radiotherapy is warranted and define the target volume based on histopathological type, stage, and grade of the tumor. After 2013, new case series with improved methodology and sample size are published, which adds new information to the literature. In one case series, 22 patients with spermatic cord sarcoma were discussed, while in another study, long-term outcome analysis of 51 patients was discussed, and another study discussed eight patients.
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Affiliation(s)
- Anil Gupta
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, IN
| | - Rashi Kulshrestha
- Clinical Radiation Oncology fellowship program, Department of Radiation Oncology, BC Cancer Agency, Abbotsford, BC, CA
| | - Kamal Kishore
- Department of Biostatistics, Post Graduate Institute of Medical Education and Research, Chandigarh, IN
| | - Oliver Micke
- Prof. Dr. med, Klinik für Strahlentherapie und Radioonkologie, Franziskus Hospital, Kiskerstrasse, Bielefeld, DE
| | - Rishabh Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, IN
| | - Kanika Garg
- Department of Anaesthesiology, Employee's State Insurance Corporation, Noida, IN
| | - Dayanand Sharma
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi & National Cancer Institute, Jhajjar, Haryana, IN
| | - Rambha Pandey
- Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, IN
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14
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Li L, Liang J, Song T, Yin S, Zeng J, Zhong Q, Feng X, Jia Z, Fan Y, Wang X, Lin T. A Nomogram Model to Predict Prognosis of Patients With Genitourinary Sarcoma. Front Oncol 2021; 11:656325. [PMID: 33937065 PMCID: PMC8085422 DOI: 10.3389/fonc.2021.656325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/22/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives The aim of this study is to evaluate the significant factors influencing the overall survival (OS) and recurrence free survival (RFS) and make an attempt to develop a nomogram for predicting the prognosis of patients with genitourinary sarcoma (GS). Methods Data on adult GS from 1985 to 2010 were collected. The impact of clinical factors on OS and RFS were estimated by Kaplan–Meier (KM) analysis, and differences between groups were analyzed by the log-rank test. To establish a nomogram, all patients were randomly divided into a training set (n = 125) and a testing set (n = 63). Cox proportion hazard model was utilized to assess the prognostic effect of variables. Then, a nomogram was established to estimate 1-, 3-, and 5-year OS based on Cox regression model. Subsequently, the nomogram was validated by a training set and a validation set. Results A total of 188 patients were enrolled into our study. Male patients with bladder sarcoma had better OS rather than RFS when stratified by gender (P = 0.022). According to histological subtypes, patients with leiomyosarcoma (LMS) undergoing chemotherapy were associated with favorable OS (P = 0.024) and RFS (P = 0.001). Furthermore, LMS in kidney sarcoma were associated with lower recurrence rate in comparison to rhabdomyosarcoma (RMS) (P = 0.043). Margin status after surgical excision markedly influenced the OS and RFS of GS patients and negative margins presented optimal prognosis. Chemotherapy was associated with improved OS for patients without surgery (P = 0.029) and patients with positive margins (P = 0.026). Based on the multivariate analysis of the training cohort, age, gender, surgery status, histological subtype, and chemotherapy were included in our nomogram for prediction of OS. The nomogram had sufficient power with concordance index (C-index) of OS: 0.770, 95%CI: 0.760–0.772 and area under curve (AUC) of OS: 0.759, 95%CI: 0.658–0.859 in the training set and with C-index of OS: 0.741, 95%CI: 0.740–0.765, and AUC of OS: 0.744, 95%CI: 0.576–0.913 in the validation set. Conclusions Adults GS is a group of extremely rare tumors with poor prognosis. Of all histological types, LMS is sensitive to chemotherapy. We highlighted the cardinal role of surgical resection and the importance of achieving negative margins. We identified the efficacy of chemotherapy for patients with positive margins and those without surgery as well. A nomogram is validated as an effective tool predicting short-term outcomes.
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Affiliation(s)
- Linde Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiayu Liang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Turun Song
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Saifu Yin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Zeng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Zhong
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaobing Feng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zihao Jia
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Fan
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xianding Wang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Lin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China.,Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
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15
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Angiosarcoma of the Urinary Bladder Following Radiotherapy: Report of a Case and Review of the Literature. ACTA ACUST UNITED AC 2021; 57:medicina57040329. [PMID: 33915778 PMCID: PMC8066026 DOI: 10.3390/medicina57040329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 11/16/2022]
Abstract
Background and objectives: Angiosarcomas are uncommon and extremely aggressive malignancies derived from vascular endothelial cells. Although they can occur anywhere in the body and at any age, they are more frequently found in the skin of the head and neck regions and in the elderly. Few cases have been recorded in deep soft tissues and in parenchymal organs. Angiosarcomas of the urinary bladder are exceedingly rare. They usually arise in adult patients with a history of radiation therapy, cigarette smoking, or exposure to chemical agents (e.g., vinyl chloride). Despite multidisciplinary treatment approaches combining surgery, radiotherapy, and chemotherapy, prognosis is dismal. Materials and Methods: We describe a case of a 78-year-old Caucasian man presenting with a vesical mass incidentally discovered with abdominal computerized tomography (CT). He underwent transurethral resection of the bladder (TURB), and histology was compatible with angiosarcoma. Results: The patient had been a heavy smoker and his medical history included therapeutic irradiation for prostate cancer eight years previously. Radical cystoprostatectomy was feasible, and pathologic examination of the surgical specimen confirmed angiosarcoma involving the urinary bladder, prostate, and seminal vesicles. Post-operative peritonitis resulted in progressive multi-organ failure and death. Conclusions: Angiosarcoma primary to the urinary bladder is seldom encountered, however, it should be considered in the differential diagnosis of vesical tumors, especially in elderly men with a history of pelvic radiotherapy.
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16
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Delport JE, Makamba K. Early radical cystectomy with negative margins in a 57-year-old female with myxoid/round cell liposarcoma of the bladder suggests prolonged overall survival. AFRICAN JOURNAL OF UROLOGY 2021; 27:52. [PMID: 33776408 PMCID: PMC7985921 DOI: 10.1186/s12301-021-00152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background Bladder cancer is the 17th most common cancer in the female population. Most bladder cancers are of urothelial origin. Sarcomas of the bladder are very uncommon. Case presentation This case concerns a 57-year-old female from a rural town in the Eastern Cape who was diagnosed with myxoid/round cell liposarcoma of the bladder. After the initial transurethral resection of the bladder tumour, she underwent an anterior exenteration with Bricker’s diversion (ileal conduit) and negative margins were achieved. Conclusions Sarcomas of the bladder are known to have a poor prognosis. Our patient is alive with good stoma function more than 24 months since her radical surgery. We are of the opinion that her favourable overall survival is attributable to early radical surgical intervention with negative margins.
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Affiliation(s)
- Johannes Eduard Delport
- Medical Officer, Department of Urology, Port Elizabeth Provincial Hospital, Buckingham Road, Mount Croix, Port Elizabeth, Eastern Cape South Africa
| | - Khanyisa Makamba
- Head of Clinical Unit, Department of Urology, Port Elizabeth Provincial Hospital, Buckingham Road, Mount Croix, Port Elizabeth, Eastern Cape South Africa
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17
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Urological Sarcoma Among the Iranian Population; A National Registry-Based Study. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.103700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Sarcomas of the genitourinary tract are rare clinical entities with relatively few studies conducted on their prevalence and characteristics globally. Previous literature has established the effects of ethnicity and race on soft tissue sarcomas’ clinical attributes and prognosis. Objectives: To provide researchers and clinicians with a better understanding of the matter, this study aims at providing descriptive data regarding urologic sarcoma among the Iranian population. Methods: All patients diagnosed with genitourinary sarcoma registered in the Cancer Research Center (CRC) between 2009 and 2014 were enrolled in this national population-based study. Basic patient data including their gender, age, city, and province of origin, as well as each patient’s tumor characteristics were retrieved from CRC’s database. Chi-square test was utilized in determining a possible relationship between patient data and the tumor characteristics. Results: A total of 337 patients with primary genitourinary sarcoma were selected for this study. More than half of the patients were classified in the 15 to 65-year-old group. The most common primary site of involvement was the kidneys with the most prevalent histological subtype being liposarcoma. Conclusions: This study found sarcomas of the genitourinary tract to be more prevalent among the adult Iranian population, with liposarcoma, leiomyosarcoma, and rhabdomyosarcoma being the most commonly observed subtype, and factors such as age, gender, and tumor grading all related to the anatomical distribution of the tumors.
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18
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Iafrate M, Motterle G, Zaborra C, Leone N, Prayer-Galetti T, Zattoni F, Guttilla A, Cappellesso R, Dei Tos AP, Rossi CR, Del Fiore P, Rastrelli M, Mocellin S. Spermatic Cord Sarcoma: A 20-Year Single-Institution Experience. Front Surg 2020; 7:566408. [PMID: 33282904 PMCID: PMC7705095 DOI: 10.3389/fsurg.2020.566408] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction: Spermatic cord sarcomas represent a rare genitourinary malignancy with a challenging diagnostic and therapeutic pathway. Different histotypes have been described and prognostic factors remain poorly defined due to the paucity of data presented in literature. Methods: Retrospective chart review of 22 adult patients treated for spermatic cord sarcoma in a single institution in the last 20 years was performed. Clinicopathological characteristics of the tumors were collected with primary and subsequent treatment. Survival analysis was performed in order to identify prognostic factors of disease-specific survival. Results: The median age at diagnosis was 68 years (58–78), the most common histotype was liposarcoma (14/22), and most patients (63.6%) were found to have positive surgical margins after surgery. The 5-year cancer specific survival was 91.3%. Grading (p = 0.480), histotype (p = 0.327), and type of intervention (p = 0.732) were not associated with survival. All patients dead of disease had positive surgical margins (p = 0.172). Conclusion: We report a good prognosis at 5 years. Wide radical resection remains the first and probably the most important step; thus, according also to literature, negative surgical margins should be aimed.
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Affiliation(s)
- Massimo Iafrate
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Giovanni Motterle
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Carlotta Zaborra
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Niccolò Leone
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Tommaso Prayer-Galetti
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Filiberto Zattoni
- Urology Clinic Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Andrea Guttilla
- Clinica Urologica dell'Ospedale di Camposampiero, Camposampiero, Italy
| | - Rocco Cappellesso
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Carlo Riccardo Rossi
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
| | - Paolo Del Fiore
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Marco Rastrelli
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Simone Mocellin
- Surgical Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy.,Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padua, Padua, Italy
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Urasaki T, Nakano K, Tomomatsu J, Komai Y, Yuasa T, Yamashita K, Takazawa Y, Yamamoto S, Yonese J, Takahashi S. Adult genitourinary sarcoma: The era of optional chemotherapeutic agents for soft tissue sarcoma. Int J Urol 2020; 28:91-97. [PMID: 33169456 DOI: 10.1111/iju.14417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/27/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To report our institutional experience with treatment of primary genitourinary soft tissue sarcoma. METHODS We retrospectively reviewed the medical records of adult soft tissue sarcoma patients treated between March 2005 and May 2019. The primary tumor sites included the prostate, kidney, urinary bladder and the paratesticular structures. RESULTS A total of 19 patients - 16 men (84%) and three women (16%) - were enrolled in the study. The median age was 41 years (range 20-79 years). The most common primary site was the prostate (in eight patients; 42%), and prostatic sarcoma patients were younger than patients with sarcomas of other origins. The most common histological subtype was leiomyosarcoma (in five patients; 26%). The overall survival rates after 1, 3 and 5 years were 61.5%, 34.4% and 25.8%, respectively. The median survival time was 20.7 months (95% confidence interval 5.9-35.5 months). Univariate analysis showed that an absence of metastasis at diagnosis and complete surgical resection were predictive of favorable survival. In the chemotherapy group, the objective response rate was 20.5%. Pazopanib was administered to nine patients in the late-line setting, and the objective response rate was 11.1%; six grade ≥3 adverse events were observed in three patients. CONCLUSIONS Inoperable metastatic genitourinary soft tissue sarcoma remains difficult to treat, as previously reported. Further investigation on this malignancy, including optimization of currently available antitumor drugs and the development of novel therapeutic agents, is required.
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Affiliation(s)
- Tetsuya Urasaki
- Departments of, Department of, Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kenji Nakano
- Departments of, Department of, Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junichi Tomomatsu
- Departments of, Department of, Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinobu Komai
- Department of, Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Yuasa
- Department of, Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kyoko Yamashita
- Department of, Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yutaka Takazawa
- Department of, Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Yamamoto
- Department of, Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Yonese
- Department of, Urology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shunji Takahashi
- Departments of, Department of, Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
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20
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Nazemi A, Daneshmand S. Adult genitourinary sarcoma: A population-based analysis of clinical characteristics and survival. Urol Oncol 2020; 38:334-343. [DOI: 10.1016/j.urolonc.2019.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/29/2019] [Accepted: 12/02/2019] [Indexed: 01/31/2023]
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21
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Aggarwal S, Mitra S, Dewan A, Durga G. Carcinosarcoma prostate with osteosarcomatous differentiation: a rare de novo presentation. BMJ Case Rep 2019; 12:12/6/e230116. [PMID: 31196973 DOI: 10.1136/bcr-2019-230116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Carcinosarcoma is a rare histological event in the history of prostatic malignancies. Historically aggressive tumours with dismal outcomes reported in scarce literature available so far. Very few recent studies suggest good outcomes with modern era surgery and radiotherapy techniques in localised disease. The case presented here had no history of known risk factors like prior adenocarcinoma or prior radiation therapy. This case presented with obstructive urinary symptoms with no prostate-specific antigen elevation, diagnosed with imaging, managed aggressively with robotic surgery. Detailed immunohistochemistry and pathological review suggested diagnosis as carcinosarcoma with osteosarcomatous differentiation. Very rare such cases were reported in the past with complete clinical, radiological, pathological details and managed aggressively with good outcomes. The patient is disease free after 6 months of follow-up.
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Affiliation(s)
- Sumeet Aggarwal
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
| | - Swarupa Mitra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
| | - Abhinav Dewan
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
| | - Garima Durga
- Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India
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22
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Yakirevich E, Madison R, Fridman E, Mangray S, Carneiro BA, Lu S, Cooke M, Bratslavsky G, Webster J, Ross JS, Ali SM. Comprehensive Genomic Profiling of Adult Renal Sarcomas Provides Insight into Disease Biology and Opportunities for Targeted Therapies. Eur Urol Oncol 2019; 4:282-288. [PMID: 31412008 DOI: 10.1016/j.euo.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/12/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Primary adult renal sarcomas (RSs) are rare aggressive neoplasms. Clinical outcomes are extremely poor, and optimal treatment remains challenging. OBJECTIVE To identify genomic alterations (GAs) in patients with RSs. DESIGN, SETTING, AND PARTICIPANTS Comprehensive genomic profiling (CGP) was conducted on DNA/RNA extracted from formalin-fixed paraffin-embedded tissue using the FoundationOne Heme/Sarcoma assay in 13 adult, locally advanced or metastatic RSs of various histologic types. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS All classes of GAs, including base substitutions, small indels, rearrangements, copy number alterations, tumor mutational burden (TMB), and microsatellite instability (MSI), were analyzed. RESULTS AND LIMITATIONS CGP revealed 55 GAs (4.2 per tumor), 29 of which were clinically relevant genomic alterations (CRGAs; 2.2 per tumor). At least one CRGA was detected in nine (69%) cases. High-level amplifications (more than six copies) involving 4q12 amplicon of the KIT and PDGFRA genes were identified in four (31%) cases (two undifferentiated pleomorphic sarcomas [UPSs], one sarcomatoid renal cell carcinoma, and one myxofibrosarcoma). Both UPSs also had KDR gene amplification in addition to KIT and PDGFRA. Additional CRGAs were found in CDKN2A/B (23%), NF1 (23%), and MET (8%). All RSs were MSI stable, the mean TMB was 3.5 mutations/megabase (Mb), and none (0%) featured TMB >10 mutations/Mb. Limitations include the small sample size. CONCLUSIONS RSs are characterized by diverse histology and genomic profiles including 31% of cases with 4q12 amplification harboring the KIT/PDGFRA/KDR genes. Of the tumors, 69% carry CRGAs, which could lead to potential benefit from targeted therapies; however, a low TMB also suggests that these cases are unlikely to respond to checkpoint inhibitors. PATIENT SUMMARY This study provides insights into molecular biology of renal sarcoma, a rare aggressive subtype of kidney tumors. We demonstrated that renal sarcomas harbor unique, recurrent, clinically relevant molecular abnormalities that provide new opportunities for targeted therapies.
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Affiliation(s)
- Evgeny Yakirevich
- Department of Pathology, Rhode Island Hospital, Providence, RI, USA; Alpert Medical School at Brown University, Providence, RI, USA.
| | | | - Eduard Fridman
- Department of Pathology, Sheba Medical Center, Tel-Aviv, Israel
| | - Shamlal Mangray
- Department of Pathology, Rhode Island Hospital, Providence, RI, USA; Alpert Medical School at Brown University, Providence, RI, USA
| | - Benedito A Carneiro
- Alpert Medical School at Brown University, Providence, RI, USA; Hematology/Oncology Division, Lifespan Cancer Institute, Department of Internal Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Shaolei Lu
- Department of Pathology, Rhode Island Hospital, Providence, RI, USA; Alpert Medical School at Brown University, Providence, RI, USA
| | | | | | | | | | - Siraj M Ali
- Foundation Medicine Inc., Cambridge, MA, USA
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Pan HC, Sun CY, Wu IW, Tsai TL, Sun CC, Lee CC. Higher risk of malignant neoplasms in young adults with end-stage renal disease receiving haemodialysis: A nationwide population-based study. Nephrology (Carlton) 2018; 24:1165-1171. [PMID: 30584693 PMCID: PMC6849784 DOI: 10.1111/nep.13555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2018] [Indexed: 12/22/2022]
Abstract
Aim Previous investigations have shown that end‐stage renal disease (ESRD) is associated with an increased risk of malignancies. The aim of this study was to explore the association between ESRD in patients undergoing maintenance haemodialysis (HD) and the incidence of malignancies according to age. Methods We analysed a nationwide cohort retrieved from Taiwan's National Health Insurance Research Database to study the incidence of malignancies in patients who were and were not receiving HD. One million beneficiaries were randomly selected and followed from 2005 to 2013. Of these 1 000 000 patients, 3055 developed ESRD and commenced maintenance HD during this period. For each HD patient, four age‐, gender‐ and diabetes‐matched controls were selected from the database (n = 12 220). We further stratified the patients according to age. The study endpoint was the occurrence of malignancy. Results The incidence rates of malignancy were 6.8% and 4.9% in the HD and control groups, respectively. Competing risk regression analysis indicated that age, HD, male gender and diabetes were associated with an increased risk of malignancy. When further stratified according to age, the odds ratios of developing cancer were 5.8, 1.9, 1.9 and 1.5 among the HD patients aged <40 years, 40–49 years, 50–59 years and 60–69 years, respectively. Conclusion The patients with ESRD who received HD had a significantly higher cumulative risk of malignancy, especially those with a young age. Therefore, specialized cancer screening protocols for young HD patients might help to prolong their lifespan. End‐stage kidney disease is associated with an increased risk of many malignancies. This epidemiological study from Taiwan reviews the incidence rates of malignancies in a large haemodialysis cohort compared to a control group, revealing a higher cumulative risk of malignancies especially in those of a young age on dialysis.
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Affiliation(s)
- Heng-Chih Pan
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Chiao-Yin Sun
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taipei, Taiwan
| | - I-Wen Wu
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Tien-Ling Tsai
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chi-Chin Sun
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taipei, Taiwan.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chin-Chan Lee
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taipei, Taiwan
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Vuruskan BA, Ozsen M, Coskun B, Yalcinkaya U. Evaluation of incidence and histolopathological findings of soft tissue sarcomas in genitourinary tract: Uludag university experience. Int Braz J Urol 2018; 45:68-73. [PMID: 30044590 PMCID: PMC6442136 DOI: 10.1590/s1677-5538.ibju.2018.0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/18/2018] [Indexed: 01/26/2023] Open
Abstract
Purpose: In this study we aimed to review urological soft tissue sarcomas of genitourinary tract that were diagnosed in our institution and their prognostic factors for survival. Materials and Methods: The clinical and pathological records of 31 patients who had diagnosis of soft tissue sarcomas primarily originating from the genitourinary tract between 2005-2011 were reviewed. Results: The most common site was kidney (17 cases, 54.8%), and most common diagnosis was leiomyosarcoma (11 cases, 35.4%). A total of 24 patients (77.4%) had surgical excision. The surgical margins were positive in 7 patients who presented with local recurrence after primary resection. Twelve patients developed metastatic disease. During follow-up (range 9-70 month), 26 of the 31 patients (88.9%) were alive. Significant survival differences were found according to histological type (p: 0.001), with lower survival rates for malignant fibrous histiocytoma. The tumor size, the presence of metastasis at the time of diagnosis and tumor localization were not statistically significant for overall survival. Conclusions: In our series, prostate sarcomas, paratesticular rhabdomyosarcoma and malignant fibrous histiocytoma had poor prognosis, especially in patients presenting with metastatic disease.
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Affiliation(s)
- Berna Aytac Vuruskan
- Department of Surgical Pathology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Mine Ozsen
- Department of Surgical Pathology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Burhan Coskun
- Department of Urology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Ulviye Yalcinkaya
- Department of Surgical Pathology, Uludag University, Faculty of Medicine, Bursa, Turkey
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Campobasso D. Editorial Comment from Dr Campobasso to Adult genitourinary sarcoma: Clinical characteristics and survival in a series of patients treated at a high-volume institution. Int J Urol 2017; 24:432. [DOI: 10.1111/iju.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Davide Campobasso
- Urology Unit; Civil Hospital of Guastalla; AUSL of Reggio Emilia; Reggio Emilia Italy
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Wang X, Tu X, Tan P, Zhan W, Nie P, Wei B, Li X, Chen L, Lu Y, Han P. Adult genitourinary sarcoma: Clinical characteristics and survival in a series of patients treated at a high-volume institution. Int J Urol 2017; 24:425-431. [PMID: 28470716 DOI: 10.1111/iju.13345] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 03/05/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To report our institutional experience in the management of adult genitourinary sarcoma. METHODS This was a retrospective analysis of data on adult genitourinary sarcoma treated at the West China Hospital, Sichuan University, Chengdu, Sichuan, China from 1985 to 2010. Clinicopathological parameters were analyzed to determine their impact on overall, recurrence-free and metastasis-free survivals. RESULTS A total of 46 women and 142 men were included, with a median age of 42 years. Of these, 152 cases were high-grade. The most common site was the paratesticular region. Surgical resection was carried out in 155 patients (82.4%), with negative margin in 106. After a minimum follow up of 5 years, 20 patients (11.6%) survived disease-free, 14 (8.1%) were alive with disease and 138 (80.2%) died of disease. Survival rates at 1, 3 and 5 years were 91.3%, 64.0% and 47.7%. In univariate analyses, liposarcoma, high grade, metastasis at diagnosis, a lack of surgical resection and positive margin were predictive of unfavorable survival. In multivariate analyses, high grade, a lack of surgical resection and chemotherapy were independent predictors of poor survival. CONCLUSIONS Adult genitourinary sarcoma is an aggressive malignancy, usually presenting at advanced stage, with a high incidence of recurrence and metastasis. Complete resection and selective combination of chemotherapy and radiotherapy might constitute the optimal treatment for this disease.
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Affiliation(s)
- Xianding Wang
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiang Tu
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Ping Tan
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Wenli Zhan
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Pan Nie
- West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Bing Wei
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaohong Li
- Department of Health Statistics, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Libo Chen
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yiping Lu
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ping Han
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Varnavas M, Lee E, Donaldson P. Subcutaneous leiomyosarcoma of the scrotum – a case presentation and review of the literature. JOURNAL OF CLINICAL UROLOGY 2017. [DOI: 10.1177/2051415814560082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Michalis Varnavas
- Urology Department, Ipswich Hospital NHS Trust, Heath Road, Ipswich, IP4 5PD, UK
| | - Elaine Lee
- Urology Department, Ipswich Hospital NHS Trust, Heath Road, Ipswich, IP4 5PD, UK
| | - Peter Donaldson
- Urology Department, Ipswich Hospital NHS Trust, Heath Road, Ipswich, IP4 5PD, UK
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Abstract
PURPOSE OF REVIEW The purpose of this article was to describe the systemic therapy of genito-urinary sarcomas. RECENT FINDINGS High rate of distant metastasis and high mortality rate has brought interest into the development of new therapeutic approaches. Various modules of chemotherapy were sampled in sarcoma treatment, although clinical response is still unsatisfactory. Chemotherapy in sarcomas can be used as neoadjuvant or adjuvant to the surgery. There is no consensus on the current role of adjuvant chemotherapy. Study results are conflicting; therefore, conclusions drawn from the studies are uncertain. In general, the adjuvant chemotherapy is not standard treatment in adult-type sarcomas. In addition, chemotherapy for advanced and metastatic sarcoma disease, as well as second-line chemotherapy, was discussed. SUMMARY The best treatment for sarcomas in case of organ-confined disease and in selected cases of locally advanced disease seems to be surgery followed by chemotherapy. In case of metastasis stage of sarcoma, preoperative chemotherapy with surgery of residual masses should be considered as first-line treatment followed by postoperative chemotherapy. The treatment of patient with highly advanced disease and/or unresectable metastases should be individualized (chemotherapy, radiotherapy and best supportive care).
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Hugar LA, Quiroga-Garza GM, Davies BJ, Hrebinko RL, Tran T, Jacobs BL. Molecular Cytogenetics as a Diagnostic Aid for Primary Liposarcoma of the Spermatic Cord. Clin Genitourin Cancer 2016; 15:e83-e89. [PMID: 27666164 DOI: 10.1016/j.clgc.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Lee A Hugar
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | | | - Benjamin J Davies
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ronald L Hrebinko
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Thu Tran
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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A Review of the Literature on Primary Leiomyosarcoma of the Prostate Gland. Adv Urol 2015; 2015:485786. [PMID: 26640482 PMCID: PMC4659954 DOI: 10.1155/2015/485786] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/24/2015] [Accepted: 10/04/2015] [Indexed: 12/20/2022] Open
Abstract
Primary leiomyosarcoma of the prostate (PLSOP) is rare, with less than 200 cases reported so far. PLSOPs present with lower urinary tract symptoms, haematuria, and perineal pain; may or may not be associated with a history of previous treatment for adenocarcinoma of prostate by means of radiotherapy and or hormonal treatment; may afflict children and adult male. Examination may reveal benign enlarged prostate and hard enlarged mass. PLSOPs may be diagnosed by histological examination findings of spindle-shaped carcinoma cells in prostate specimens. Immunohistochemical staining tends to be positive for vimentin, CD44, smooth muscle actin, and calponin, focally positive for desmin, and at times positive for keratin. They stain negatively for PSA, S-100, CD34, CD117, and cytokeratin. Cytogenetic study on primary leiomyosarcoma of the prostate gland may show clonal chromosomal rearrangement involving Chromosomes 2, 3, 9, 11, and 19. On the whole the prognosis is poor. Surgery with or without chemotherapy would appear to be the mainstay of treatment for PLSOPs that are operable, but generally there is no consensus opinion on the best therapeutic approach. Most cases of PLSOPs are diagnosed in an advanced stage of the disease. A global multicenter trial is required to find therapies that would improve the prognosis.
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Gao L, Song H, Mu K, Wang J, Guo B, Shi B, Li G. Primary epididymis malignant triton tumor: case report and review of the literature. Eur J Med Res 2015; 20:79. [PMID: 26392076 PMCID: PMC4576369 DOI: 10.1186/s40001-015-0172-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 09/07/2015] [Indexed: 12/12/2022] Open
Abstract
Background
Malignant triton tumor (MTT) is a rare and histological complexity characterized by a mixture of peripheral nerve sheath tumors and with rhabdomyoblastic differentiation. It follows a particularly malignant course.
Case presentation In the present study, we report the first MTT of epididymis. The patient is a 22-year-old male presented with swelling in the left scrotum over a 2-month period. He did not have the history or symptoms of neurofibromatosis type 1. A mass measured about 3 cm × 4 cm was found in the left epididymis by ultrasound and CT scan. It was diagnosed as epididymis tumor and underwent exploration; intraoperative frozen section was diagnosed malignant tumor and treated with radical orchidoepididymectomy. The pathological report was malignant triton tumor. Despite taken high-dose radiation therapy and followed by chemotherapy for four cycles, he was died of progressive disease with multiple metastases 26 months after surgery. The clinic pathologic characteristics and optimal treatment strategy are reviewed.
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Affiliation(s)
- Lijian Gao
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China. .,Department of Urology, Dezhou People Hospital, Dezhou City, Shandong Province, China.
| | - Hualin Song
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Pingjiang Road, No 23, He Xi District, Tianjin, 300211, China.
| | - Kun Mu
- The Second Department of Breast Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.
| | - Jiaxin Wang
- Department of Head and Neck Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, 300060, China.
| | - Baoyin Guo
- Department of Urology, Tianjin Baodi Hospital of Tianjin Medical University, Tianjin, 300321, China.
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
| | - Gang Li
- Department of Urology, Second Hospital of Tianjin Medical University, Tianjin Institute of Urology, Pingjiang Road, No 23, He Xi District, Tianjin, 300211, China.
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Küçük Ü, Bayol Ü, Pala EE, Akman Ö, Divrik RT. Paratesticular sarcomas: our case series. Turk J Urol 2015; 39:84-9. [PMID: 26328086 DOI: 10.5152/tud.2013.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 12/20/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Paratesticular tumors, which comprise a heterogeneous group of entities, are often described in case reports in the literature. In this study, we present histomorphological, immunohistochemical and clinical features of six cases with paratesticular sarcoma. MATERIAL AND METHODS Six cases with paratesticular sarcoma diagnosed in our hospital between 1997 and 2012 were included in this study. Information regarding treatment modalities, tumor recurrence, metastasis, and survival were obtained from archival patient records. Hematoxylin-eosin sections of the cases were examined, and immunohistochemical analyses were performed for markers including smooth muscle actin, desmin, Ki67, CD34, S100 and myogenin. Percentage of staining in five high-power fields were counted to document Ki67 and p53 nuclear positivity rates. RESULTS Of the 6 paratesticular sarcoma cases, 3 were rhabdomyosarcomas, 2 leiomyosarcomas and 1 liposarcoma. The case with sclerotic-type liposarcoma showed two recurrences during the 15-year follow-up period. Two cases with the diagnosis of leiomyosarcoma presented with lung metastases at the time of diagnosis, and 1 patient died of the disease at 7(th) month. Of the 3 cases with rhabdomyosarcomas, 2 patients were lost to postoperative follow up. The other patient presented with liver and prevertebral metastasis at the 3(rd) month and died of the disease in the 14(th) month. The Ki67 proliferation index was significantly higher for one case with rhabdomyosarcoma, and 2 cases with leiomyosarcoma. Differences in p53 expression were not statistically significant between the cases. CONCLUSION Paratesticular tumors belong to a heterogeneous group of tumors that can follow different clinical courses. This study showed that the most important features in determining prognosis are histopathological subtype and tumor grade.
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Affiliation(s)
- Ülkü Küçük
- Clinic of Pathology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ümit Bayol
- Clinic of Pathology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Emel Ebru Pala
- Clinic of Pathology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Özlem Akman
- Clinic of Pathology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
| | - Rauf Taner Divrik
- Clinic of Urology, İzmir Tepecik Training and Research Hospital, İzmir, Turkey
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Moreira DM, Gershman B, Thompson RH, Okuno SH, Robinson SI, Leibovich BC, Boorjian SA. Clinicopathologic characteristics and survival for adult renal sarcoma: A population-based study. Urol Oncol 2015; 33:505.e15-20. [PMID: 26321056 DOI: 10.1016/j.urolonc.2015.07.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To analyze the association of clinicopathologic characteristics and treatment modality with survival among adult patients with renal sarcoma. METHODS We identified 489 adults diagnosed with renal sarcoma from the Surveillance, Epidemiology and End Results registry between 1973 and 2011. Cancer-specific survival was estimated using the Kaplan-Meier method and was compared between groups with log rank and Cox models. RESULTS Median age at diagnosis was 61 years, while median tumor size was 11 cm. Tumor histology was leiomyosarcoma in 175, liposarcoma in 100, other subtypes in 129, and unknown in 85 cases. Tumor stage at diagnosis was nonmetastatic in 322 (67%) and metastatic in 167 (33%) cases. Treatment of nonmetastatic disease was surgical resection in 171 patients, radiation in 24, both in 35, neither in 18, and unknown in 74 cases. Treatment of metastatic disease was surgery in 39 patients, radiation in 27, both in 11, neither in 42, and unknown in 48. For nonmetastatic and metastatic disease, 5-year cancer-specific survival rates were 58% and 16%, respectively. On multivariable analysis, surgery was associated with decreased cancer-specific mortality among both patients with nonmetastatic disease (hazard ratio = 0.34; 95% CI: 0.14-0.85) and those with metastatic disease (hazard ratio = 0.38; 95% CI: 0.18-0.77). Age, race, tumor size, and tumor grade were independently associated with cancer death in nonmetastatic disease, whereas race and tumor histology remained associated with mortality in metastatic disease (all P < 0.05). CONCLUSION Although metastatic renal sarcoma has an ominous prognosis, durable survival may be achieved for localized tumors. Although we recognize the potential for selection bias, our results suggest an association between surgical resection and decreased mortality for both nonmetastatic and metastatic renal sarcoma.
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Unal OU, Oztop I, Menekse S, Urakci Z, Bozkurt O, Ozcelik M, Gunaydin Y, Yasar N, Yazilitas D, Kodaz H, Taskoylu BY, Aksoy A, Demirci U, Araz M, Tonyali O, Sevinc A, Yilmaz AU, Benekli M. Adult Urological Soft Tissue Sarcomas: A Multicenter Study of the Anatolian Society of Medical Oncology (ASMO). Asian Pac J Cancer Prev 2015; 16:4777-80. [PMID: 26107239 DOI: 10.7314/apjcp.2015.16.11.4777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To analyze clinicopathological characteristics, prognostic factors and survival rates of the patients with urological soft tissue sarcomas treated and followed up in Turkey. MATERIALS AND METHODS For overall survival analyses the Kaplan-Meier method was used. From medical records, nine prognostic factors on overall survival were analysed. RESULTS For the 53 patients (34 males, 19 females) whose charts were reviewed, the median age was 53 (range 22 to 83) years. Most frequently renal location (n=30; 56.6%) was evident and leiomyosarcoma (n=20, 37.7%) was the most frequently encountered histological type. Median survival time of all patients was 40.3 (95% CI, 14.2-66.3) months. In univariate analysis, male gender, advanced age (≥50 years), metastatic stage, unresectability, grade 3, renal location were determined as worse prognostic factors. In multivariate analysis, metastatic stage, unresectability and grade 3 were determined as indicators of worse prognosis. CONCLUSIONS Urological soft tissue sarcomas are rarely seen tumours in adults. The most important factors in survival are surgical resection, stage of the tumour at onset, grade and location of the tumour, gender and age of the patients.
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Affiliation(s)
- Olcun Umit Unal
- Division of Medical Oncology, Department of Internal Medicine, Dokuz Eylul University Medical Faculty, Izmir, Turkey E-mail :
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Romero Gonzalez EJ, Marenco Jiménez JL, Mayorga Pineda MP, Martínez Morán A, Castiñeiras Fernández J. Leiomyosarcoma of the Penis, an Exceptional Entity. Urol Case Rep 2015; 3:63-4. [PMID: 26793502 PMCID: PMC4714249 DOI: 10.1016/j.eucr.2014.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 12/09/2014] [Accepted: 12/10/2014] [Indexed: 11/29/2022] Open
Abstract
In tumors of the penis, mesenchymal tumors are extremely rare and within them, sarcomas are exceptional. We report a patient with a sarcomatous lesion treated with conservative surgery with good surgical outcome and the review of the literature, to present the latest advances in the treatment of this unusual entity.
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Sohn M, Kwon T, Jeong IG, Hong S, You D, Hong JH, Ahn H, Kim CS. Histologic variability and diverse oncologic outcomes of prostate sarcomas. Korean J Urol 2014; 55:797-801. [PMID: 25512813 PMCID: PMC4265713 DOI: 10.4111/kju.2014.55.12.797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 09/11/2014] [Indexed: 11/23/2022] Open
Abstract
Purpose Primary prostate sarcomas are a rare type of prostate cancer that account for less than 0.1% of primary prostate malignancies. We analyzed the experience of a single institution with prostate sarcoma over 20 years. Materials and Methods In this case series, the medical records of 20 patients with prostate sarcoma were reviewed from June 1990 to December 2013 to identify symptoms at presentation, diagnostic procedures, metastasis presence and development, histologic subtype, French Fédération Nationale des Centres de Lutte Contre le Cancer grade, primary tumor grade and size, and treatment sequence, including surgery and preoperative and postoperative therapies. The average follow-up period was 23.6 months (range, 1.4-83.3 months). Results The average patient age was 46.3±16.7 years. Most patients presented with lower urinary tract symptoms (55%). The histologic subtype was spindle cell sarcoma in five patients (25%), rhabdomyosarcoma in three patients (15%), synovial sarcoma in three patients (15%), liposarcoma in three patients (15%), stromal sarcoma in three patients (15%), and Ewing sarcoma, nerve sheath tumor, and adenocarcinoma with sarcomatoid component (5% each). For liposarcoma, two patients were alive after complete surgical resection and had a good prognosis. At last follow-up, 15 patients had died of sarcoma. The 2- and 5-year actuarial survival rates for all 20 patients were 53% and 12%, respectively (medial survival, 20 months). Conclusions The disease-specific survival rate of prostate sarcoma is poor. However, sarcoma that is detected early shows a better result with proper management including surgical intervention with radio-chemotherapy than with no treatment. Early diagnosis and complete surgical resection offer patients the best curative chance.
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Affiliation(s)
- Mooyoung Sohn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Taekmin Kwon
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungwoo Hong
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Gabriele R, Ferrara G, Tarallo MR, Giordano A, De Gori A, Izzo L, Conte M. Recurrence of paratesticular liposarcoma: a case report and review of the literature. World J Surg Oncol 2014; 12:276. [PMID: 25175606 PMCID: PMC4168198 DOI: 10.1186/1477-7819-12-276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 08/06/2014] [Indexed: 11/25/2022] Open
Abstract
Paratesticular liposarcomas are rare tumors that typically affect adult. Diagnosis is very difficult and inadequate surgical excision leads to a high rate of recurrence.We report a case of local recurrence of paratesticular liposarcoma diagnosed six months following surgery.Since there is low response to adjuvant treatments, extensive surgery remains the only curative approach, as shown by the case described here and the following review of the literature.
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Affiliation(s)
- Raimondo Gabriele
- Department of Surgery, ‘P.Valdoni’ – University of Rome ‘LaSapienza’, Rome, Italy
| | - Giuseppe Ferrara
- Department of Surgery, ‘P.Valdoni’ – University of Rome ‘LaSapienza’, Rome, Italy
| | - Maria Rita Tarallo
- Department of Surgery, ‘P.Valdoni’ – University of Rome ‘LaSapienza’, Rome, Italy
| | - Alessio Giordano
- Department of Surgery, ‘P.Valdoni’ – University of Rome ‘LaSapienza’, Rome, Italy
| | - Antonietta De Gori
- Department of Surgery, ‘P.Valdoni’ – University of Rome ‘LaSapienza’, Rome, Italy
| | - Luciano Izzo
- Department of Surgery, ‘P.Valdoni’ – University of Rome ‘LaSapienza’, Rome, Italy
| | - Marco Conte
- Department of Surgery, ‘P.Valdoni’ – University of Rome ‘LaSapienza’, Rome, Italy
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Intrascrotal Dedifferentiated Leiomyosarcoma Originating from Dartos Muscle. Case Rep Urol 2014; 2014:841929. [PMID: 25580348 PMCID: PMC4279120 DOI: 10.1155/2014/841929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/26/2014] [Accepted: 11/26/2014] [Indexed: 11/18/2022] Open
Abstract
A 46-year-old man, who had visited our hospital complaining of a small intrascrotal nodule ten years ago, returned to us because of the rapid growth of the nodule. Computed tomography revealed a heterogeneously enhanced intrascrotal tumor of approximately 4 × 3 cm. The tumor and the right testis were excised with the adhered right scrotal skin. The pathological diagnosis was pleomorphic leiomyosarcoma with dedifferentiation originating from the dartos muscle. Urological dedifferentiated leiomyosarcomas are rarely reported and the clinical features are mostly unknown. This is the first report to describe the dedifferentiated leiomyosarcoma of the dartos muscle.
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Rodríguez D, Barrisford GW, Sanchez A, Preston MA, Kreydin EI, Olumi AF. Primary spermatic cord tumors: disease characteristics, prognostic factors, and treatment outcomes. Urol Oncol 2013; 32:52.e19-25. [PMID: 24239475 DOI: 10.1016/j.urolonc.2013.08.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Experience with management of spermatic cord tumors (SCTs) is uncommon. We utilized a large population-based cancer registry to characterize the demographic, pathological, treatment characteristics, and outcomes of SCTs. MATERIAL AND METHODS The Surveillance, Epidemiology, and End Results database (1973-2007) was queried. RESULTS From the database, 362 patients were identified with SCT. The annual incidence of SCT was 0.3 cases per million and did not change over time. The most common histologic types were liposarcoma (46%), leiomyosarcoma (20%), histiocytoma (13%), and rhabdomyosarcoma (9%). The median age of diagnosis for rhabdomyosarcomas was (26.3 y), whereas for other SCTs, it was (64.7 y) (P<0.001). On multivariate analysis, a worse outcome was observed with undifferentiated tumor grade, distant disease, positive lymph nodes, and leiomyosarcoma or histiocytoma cell histology. CONCLUSION We describe the largest cohort of SCT studied to date. Liposarcoma was most common, while leiomyosarcoma and histiocytoma histologic subtypes were observed to be the most aggressive. Multivariate analysis revealed that tumor grade, stage, histologic type, and lymph node involvement were independently predictive of prognosis.
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Affiliation(s)
- Dayron Rodríguez
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Glen W Barrisford
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Alejandro Sanchez
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Mark A Preston
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Evgeniy I Kreydin
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA
| | - Aria F Olumi
- Harvard Medical School, Massachusetts General Hospital, Department of Urology, Boston, MA.
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Kumar R, Kapoor R, Khosla D, Kumar N, Ghoshal S, Mandal AK, Radotra BD, Sharma SC. Paratesticular rhabdomyosarcoma in young adults: A tertiary care institute experience. Indian J Urol 2013; 29:110-3. [PMID: 23956511 PMCID: PMC3737665 DOI: 10.4103/0970-1591.114030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Introduction: Paratesticular rhabdomyosarcoma (RMS) is a rare tumor arising from the mesenchymal tissues of the spermatic cord, epididymis, testis and testicular tunics. It represents only 7% of all patients entered in the Intergroup Rhabdomyosarcoma Study (IRS) and 17% of all malignant intrascrotal tumors in children less than 15 years old. We present our experience in combined modality management of 10 successive patients of paratesticular RMS. Material and Methods: We retrospectively reviewed 10 patients of paratesticular RMS treated in our institute from July 2004 to December 2010. Clinical characteristics and treatment modality in form of surgery and chemotherapy (CCT) were noted. Statistical analysis was done with regards to progression-free survival (PFS) and overall survival (OS) using Kaplan-Meier survival analysis. Results: The median age of the patients was 16.5 years. The median duration of symptoms was 5 months. Five patients had retroperitoneal lymphadenopathy (RPLAP) while three had lung metastases and one had orbital metastases. All patients underwent high inguinal orchidectomy followed by systemic chemotherapy (CCT). Retroperitoneal node dissection was not a required staging procedure. Four patients had partial response to treatment while six had complete response. Mean duration of PFS was 48 months and mean OS was 56 months. Conclusions: Paratesticular RMS are rare neoplasms with aggressive growth patterns. Cure rates have dramatically improved and 60% of patients in our series had complete response. This success is due to development of multimodality and risk adapted treatment approaches.
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Affiliation(s)
- Ritesh Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Adult inguinoscrotal sarcomas: outcome analysis of 21 cases, systematic review of the literature and meta-analysis. World J Urol 2013; 32:445-51. [DOI: 10.1007/s00345-013-1124-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 06/24/2013] [Indexed: 10/26/2022] Open
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Khandekar MJ, Raut CP, Hornick JL, Wang Q, Alexander BM, Baldini EH. Paratesticular liposarcoma: unusual patterns of recurrence and importance of margins. Ann Surg Oncol 2013; 20:2148-55. [PMID: 23591942 DOI: 10.1245/s10434-013-2963-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Paratesticular liposarcoma (LPS) is a rare entity for which optimal treatment has not been defined. We sought to determine recurrence patterns and prognostic factors. METHODS A total of 25 patients with localized paratesticular LPS between 1987 and 2009 were reviewed. Actuarial local-recurrence-free survival (LRFS), disease-free-survival (DFS), and overall survival (OS) were determined using the Kaplan-Meier method. RESULTS LPS histology was well differentiated for 10 patients (40 %), de-differentiated for 14 (56 %), and pleomorphic for 1 (4 %). Final margins were positive in 8 patients (32 %). Radiation therapy (RT) was given to 10 patients; fields included inguinal canal ± scrotum and low pelvis. LRFS rates at 3 and 5 years were 76 and 67 %. The 3-year LRFS rates were lower in patients with positive margins compared with those with negative margins (29 vs 100 %, p = .0005) and in patients with recurrent versus primary disease (38 vs 83 %, p = .04). Among patients who received surgery and RT, margins remained a significant predictor of local recurrence (p = .009). Interestingly, recurrences in 4 patients tracked along gonadal vessels, and only 1 patient had a distant recurrence. OS at 5 years was 100 %. CONCLUSIONS For patients with localized paratesticular LPS, positive margins and presentation with recurrent disease are adverse prognostic factors for LRFS. LR for patients with positive margins is still high despite RT; thus aggressive surgery to attain negative margins should be attempted in all cases. The finding of regional recurrences along gonadal vessels should be validated, and imaging studies should be tailored to reflect potential patterns of disease at presentation and subsequent recurrence.
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Affiliation(s)
- Melin J Khandekar
- Harvard Radiation Oncology Program, Brigham and Women's Hospital, Boston, MA, USA
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Wang X, Liu L, Tang H, Rao Z, Zhan W, Li X, Zeng H, Zhang P, Wei B, Lin T, Wei Q, Lu Y, Li X. Twenty-five cases of adult prostate sarcoma treated at a high-volume institution from 1989 to 2009. Urology 2013; 82:160-5. [PMID: 23601444 DOI: 10.1016/j.urology.2013.01.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 12/23/2012] [Accepted: 01/20/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To analyze the clinical characteristics, treatment modalities, and outcomes of adult prostate sarcoma treated at our institution. MATERIALS AND METHODS The medical records of 25 adult patients with prostate sarcoma were obtained from January 1989 to December 2009. The clinicopathologic parameters were evaluated to determine their effect on survival. RESULTS The median age was 37 years (range 18-81). The median tumor size was 9.5 cm (range 4-25). The median serum prostate-specific antigen level was 1.39 ng/mL (range 0.39-33.20). The most common symptom was dysuria (72%). Transrectal ultrasound-guided needle biopsy was used to diagnose 22 sarcomas, transurethral resection of the prostate to diagnose 2, and open surgery to diagnose 1. The predominant histologic subtype was leiomyosarcoma (40%); 21 (88%) were high grade and 6 patients had metastatic disease. Surgical resection of curative intent was performed in 14 patients, with negative margins in 10. After a median follow-up of 21 months (range 5-63), 2 patients were disease free, 4 were alive with disease, and 19 had died of their disease. Overall, the 1-, 2-, 3-, and 5-year survival rate was 80.0%, 47.4%, 22.6%, and 11.3%, respectively, and the median survival time was 23 months. The median survival time after recurrence was 20 months (range 9-39) and that after metastasis was 10 months (range 3-23). Age >50 years, metastasis at presentation, and a lack of surgery with curative intent were independently predictive of an unfavorable outcome. CONCLUSION Adult prostate sarcoma accounted for 0.7% of primary prostate malignancies and carried a poor prognosis. Early diagnosis and surgical resection with curative intent offer patients the best chance of survival.
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Affiliation(s)
- Xianding Wang
- Department of Urology, Sichuan University, Chengdu, Sichuan, People's Republic of China
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Guttilla A, Crestani A, Zattoni F, Secco S, Iafrate M, Vianello F, Valotto C, Prayer-Galetti T, Zattoni F. Spermatic Cord Sarcoma: Our Experience and Review of the Literature. Urol Int 2013; 90:101-5. [DOI: 10.1159/000343277] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 08/31/2012] [Indexed: 11/19/2022]
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Silva CHW, Claros OR, Amselem I, Sá NS, Fugita OEH. Spindle-cell carcinoma of the prostate. AUTOPSY AND CASE REPORTS 2012; 2:55-61. [PMID: 31528563 PMCID: PMC6735638 DOI: 10.4322/acr.2012.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 03/03/2012] [Indexed: 11/24/2022] Open
Abstract
Sarcoma of the prostate and sarcomatoid carcinoma of the prostate are rare conditions, both characterized by a poor prognosis. Sarcomatoid carcinoma of the prostate typically arises from the evolution of an underlying adenocarcinoma, occasionally featuring heterologous elements, bulky disease being possible but rare. In contrast, sarcoma of the prostate derives from non-epithelial mesenchymal components of the prostatic stroma, shows rapid growth, and frequently presents as massive pelvic tumors obstructing the urinary tract at the time of diagnosis. We report the case of a 55-year-old patient with a two-month history of symptoms of urinary obstruction. The patient presented with an extremely enlarged heterogeneous prostate, although his prostate-specific antigen level was low. The lack of a history of prostatic neoplasia led us to suspect sarcoma, and a transrectal prostate biopsy was carried out. An immunohistochemical study of the biopsy specimen did not confirm the clinical suspicion. However, in view of the clinical features, we believe that sarcoma of the prostate was the most likely diagnosis. The patient received neoadjuvant chemotherapy followed by radiation therapy. At this writing, surgical resection had yet to be scheduled.
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Affiliation(s)
| | - Oliver Rojas Claros
- Department of Surgery - Hospital Universitário - Universidade de São Paulo - São Paulo/SP - Brazil
| | - Isaac Amselem
- Department of Urology - Hospital São Camilo - Santana - São Paulo/SP - Brazil
| | - Newton Soares Sá
- Department of Urology - Hospital São Camilo - Santana - São Paulo/SP - Brazil
| | - Oscar Eduardo Hidetoshi Fugita
- Department of Surgery - Hospital Universitário - Universidade de São Paulo - São Paulo/SP - Brazil.,Department of Urology - Hospital São Camilo - Santana - São Paulo/SP - Brazil
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Keskin S, Ekenel M, Basaran M, Kilicaslan I, Tunc M, Bavbek S. Clinicopathological characteristics and treatment outcomes of adult patients with paratesticular rhabdomyosarcoma (PRMS): A 10-year single-centre experience. Can Urol Assoc J 2012; 6:42-5. [PMID: 22396368 DOI: 10.5489/cuaj.11121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We report our experience with 8 consecutive adults treated for paratesticular rhabdomyosarcoma (RMS) at a single institution between 2000 and 2010. METHODS After primary surgical excision, 7 patients were classified into group I according to the Intergroup Rhabdomyosarcoma Study Group (IRSG) Postsurgical Grouping Classification, and 1 patient into group IIB. Retroperitoneal node dissection was not a required staging procedure. Adjuvant chemotherapy was administered to 7 of the 8 patients. No additional radiotherapy was administered. RESULTS The median age at diagnosis was 24 years (range: 18-60). Embryonal histology was the most common (75%) subtype. During follow-up, 3 patients experienced local relapse and 5 distant relapse. The median progression-free and overall survival times were 17.0 ± 9.9 months (range: 5-31) and 27.3 ± 1.3 months (range: 16-58), respectively. CONCLUSION Paratesticular RMS is an uncommon malignancy in adults. We confirm that patients with localized paratesticular RMS may have different prognoses. Retroperitoneal lymphadenectomy can be avoided as a treatment for paratesticular RMS after radical inguinal orchiectomy.
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Affiliation(s)
- Serkan Keskin
- Department of Medical Oncology, Institute of Oncology, University of Istanbul, Istanbul, Turkey
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Adult urologic sarcoma: experience during 2 decades. Urol Oncol 2011; 31:985-9. [PMID: 22093763 DOI: 10.1016/j.urolonc.2011.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 10/03/2011] [Accepted: 10/04/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify factors associated with long-term outcome and to report possibly meaningful clinical features in a unicentric sample of adult urologic sarcomas. MATERIALS AND METHODS Thirty-five patients treated between 1992 and 2011 were studied. Except for 3 patients, surgery was the initial treatment. The median follow-up in the surviving (censored) patients was 11.3 years. Kaplan-Meier method and competing risk analysis were used to evaluate outcome. Disease recurrence, disease-specific mortality, and overall mortality were the study endpoints. Comparisons were made with the log rank and the Pepe-Mori tests. Cox proportional hazard models were used to identify independent predictors of disease recurrence. RESULTS Only disease grade was significantly associated with all 3 study endpoints. The primary tumor site was significantly associated with disease-specific and recurrence-free survival but did not reach the significance level concerning overall survival. In the multivariate analysis, primary site and tumor grade were identified as predictors of disease recurrence. Whereas 10-year disease-specific survival was 100% in patients with low grade inguinoscrotal tumors, it was 0% in patients with high grade disease arising from other sites. CONCLUSIONS Low grade and inguinoscrotal origin are factors associated with favorable outcome in urologic sarcomas. Repeat interventions to remove or to inactivate recurrent tumors or metastases seem to provide clinical benefit in individual cases.
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Lee G, Lee SY, Seo S, Jeon S, Lee H, Choi H, Jeong BC. Prognostic factors and clinical outcomes of urological soft tissue sarcomas. Korean J Urol 2011; 52:669-73. [PMID: 22087360 PMCID: PMC3212660 DOI: 10.4111/kju.2011.52.10.669] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 07/11/2011] [Indexed: 12/02/2022] Open
Abstract
Purpose The purpose of this study was to elucidate prognostic factors for survival and clinical outcomes of rological soft tissue sarcomas (STSs). Materials and Methods This was a retrospective review of the medical records of 48 patients with urological STS treated from January 1982 to July 2009. Demographic and pathological characteristics were compared. Patients' demographics, clinico-pathological parameters, overall survival, and the factors expected to predict survival, such as sex, age at diagnosis, primary organ, surgical resection, metastasis, and mass size, were analyzed. We evaluated differences in survival on the basis of histological subtype by Kaplan-Meier analysis and multivariate Cox proportional hazards regression. Results The study included 34 males (70.8%) and 14 females (29.1%). The mean age at diagnosis was 47.1 years (range, 3 to 80). The most common site was the retroperitoneum (n=16), followed by the kidney (n=12), prostate (n=10), bladder (n=7), ureter (n=1), and paratesticular region (n=1). Nineteen patients (39.5%) had other organ metastases at diagnosis. The most common subtypes of sarcoma were leiomyosarcoma (50%), rhabdomyosarcoma (18.7%), and liposarcoma (8%). The remaining 11 cases had other histological subtypes (22.9%). Mean tumor size was 9.5 cm (range, 2.2 to 24). Thirty-three patients (68.7%) underwent surgical resection. The overall survival rate at 5 years was 51.4%. In the univariate and multivariate analysis, surgical resection, primary tumor site, and metastasis at diagnosis remained significant predictors of prognosis. Patients with retroperitoneal sarcoma had a higher overall survival rate by 5 years compared with patients with other organ sarcoma. Conclusions The overall survival rate at 5 years was 51.4%. Surgical resection, primary tumor site, and metastasis at diagnosis remained significant predictors of prognosis.
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Affiliation(s)
- Geonseok Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lacarrière E, Galliot I, Gobet F, Sibert L. Leiomyosarcoma of the corpus cavernosum mimicking a Peyronie's plaque. Urology 2011; 79:e53-4. [PMID: 21945279 DOI: 10.1016/j.urology.2011.07.1410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 07/05/2011] [Accepted: 07/26/2011] [Indexed: 10/17/2022]
Abstract
Peyronie's disease is relatively frequent and can cause pain and penile induration. Penile soft tissue tumors, however, are exceptional, with fewer than 45 cases reported since 1930. Some clinical and imagery elements could lead to earlier diagnosis through biopsy, enabling more extensive resections and, ultimately, better prognosis.
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Affiliation(s)
- Emeric Lacarrière
- Department of Urology, Rouen University Hospital, University of Rouen, France.
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50
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Cho SY, Moon KC, Cheong MS, Kwak C, Kim HH, Ku JH. Localized resectable genitourinary sarcoma in adult Korean patients: experiences at a single center. Yonsei Med J 2011; 52:761-7. [PMID: 21786440 PMCID: PMC3159947 DOI: 10.3349/ymj.2011.52.5.761] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the clinicopathological characteristics and prognosis of localized resectable genitourinary sarcomas in adults. MATERIALS AND METHODS Between September, 1996 and November, 2008, 18 consecutive cases of adults (12 men and 6 women; median age 48.8 years) who were treated for primary genitourinary sarcomas were identified. The following variables were analyzed: patient age, gender, body mass index, American Society of Anesthesiologists (ASA) score, primary organ, tumor histology, size, necrosis, Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade, and surgical margin positivity. Recurrence- free survival and disease-specific survival were the study end-points. RESULTS The most common presenting symptom was a palpable mass (six cases, 33.3%), the most common site was the kidney (six cases, 33.3%), and the most common histological subtype was leiomyosarcoma (eight patients, 44.4%). Complete resection with negative surgical margins was achieved in 13 patients (72.2%). The median follow-up period was 49.9 months (range 6.4 to 147.6). The recurrence- free survival rates at 1, 3, and 5 years were 81.6%, 66.5%, and 66.5%, respectively. Recurrence-free survival only associated significantly with ASA score (p=0.018). The disease-specific survival rate at 1, 3, and 5 years was 88.9%, 76.2%, and 67.7%, respectively. Disease-specific survival was associated significantly only with FNCLCC grade (p=0.042). CONCLUSION Although genitourinary sarcomas in adults are a rare group of tumors with a poor prognosis, some patients may have a favorable prognosis. Our findings suggest that FNCLCC grade is the most important prognostic factor for these patients.
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Affiliation(s)
- Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Kyung Chul Moon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Min Su Cheong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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