Adnexal smooth muscle hyperplasia resulting in non-traumatic testicular dislocation: A case report

Tumors of the para-testicular adnexa are very rare and are typically histologically diagnosed as adenomatoid neoplasms, leiomyomata, or smooth muscle hyperplasia. Though these masses are usually benign, the potential for malignancy and mass effect causing intrascrotal discomfort necessitate proper diagnosis and excision. Herein, we describe a unique case of gradual, atraumatic testicular dislocation in a 40-year-old male caused by smooth muscle hyperplasia of the testicular adnexa affecting the epididymis and vas deferens. This case highlights the diagnostic and surgical challenges associated with this presentation.

Chemoprevention in African American Men With Prostate Cancer

BACKGROUND

Recommendations for cancer screening are uncertain for the early detection or prevention of prostate cancer in African American men. Thus, chemoprevention strategies are needed to specifically target African American men.

METHODS

The evidence was examined on the biological etiology of disparities in African Americans related to prostate cancer. Possible chemopreventive agents and biomarkers critical to prostate cancer in African American men were also studied.

RESULTS

High-grade prostatic intraepithelial neoplasia may be more prevalent in African American men, even after controlling for age, prostate-specific antigen (PSA) level, abnormal results on digital rectal examination, and prostate volume. Prostate cancer in African American men can lead to the overexpression of signaling receptors that may mediate increased proliferation, angiogenesis, and decreased apoptosis. Use of chemopreventive agents may be useful for select populations of men.

CONCLUSIONS

Green tea catechins are able to target multiple pathways to address the underlying biology of prostate carcinogenesis in African American men, so they may be ideal as a chemoprevention agent in these men diagnosed with high-grade prostatic intraepithelial neoplasia.

Neoadjuvant Chemotherapy in Elderly Patients With Bladder Cancer: Oncologic Outcomes From a Single Institution Experience

INTRODUCTION

We conducted this study to determine if, in appropriately selected elderly patients receiving neoadjuvant chemotherapy (NAC), clinical outcomes including pathologic complete response/downstaging and overall survival were similar to a younger cohort.

METHODS

Chart review was performed on patients receiving NAC for urothelial carcinoma of the bladder (UCB) from 2004 to 2013. A total of 116 patients were identified that underwent NAC from 2004 to 2013 for ≥ cT2N0M0 UCB. Patients were excluded who received 2 cycles or less of chemotherapy (N = 18; 11 patients in the younger cohort, 7 in the elderly group; P = .74). Data was analyzed, and Kaplan-Meir analysis curves were used for survival and recurrence.

RESULTS

Forty-six elderly patients (age ≥ 70 years) (67% cisplatin-based regimen) were identified and compared with 70 (93% cisplatin-based regimen) younger patients. The estimated glomerular filtration rate, performance status, preoperative hemoglobin, and body mass index were significantly worse in elderly patients. Dose reduction and pathologic downstaging to non-muscle-invasive disease was not statistically different between older and younger patients Complete pathologic response in older patients (16%) and in the younger cohort (17%) were similar (P = .146). There was no significant difference in follow-up, recurrence, or in median overall survival between patient groups (28 months elderly vs. 35 months younger; P = .78). Age was not an independent predictor of pathologic downstaging, complete response, overall survival, or recurrence-free survival.

CONCLUSIONS

NAC in elderly patients (≥ 70 years old) demonstrated equivalent toxicity and oncologic outcomes in our single-institution cohort. Although older patients had significantly poorer performance status and renal function, there were no differences in survival or response to NAC.

Bilateral benign renal oncocytomas and the role of renal biopsy: single institution review

BACKGROUND

The goal was to assess the natural history and management of patients with pathologically proven bilateral (synchronous) RO after undergoing initial partial nephrectomy (PN).

METHODS

All patients underwent either robotic/laparoscopic or open PN by two experienced genitourinary oncologists from 2005-2013. Final pathology was determined by surgical excision, CT-guided percutaneous core biopsy (CT-biopsy) or fine needle aspiration (FNA). Patient demographics, tumor characteristics (pathologic data, location, size) type of surgery, pre/post estimated glomerular filtration rate (eGFR) and surgical complications were recorded.

RESULTS

Twelve patients were identified with bilateral RO. Median age at the time of surgery was 68 years (46-77) (Table 1). The median size of the largest tumor(s) resected was 2.75 cm (1.5-5.5 cm) and second largest tumor(s) was 1.75 cm (1.0-4.0 cm). Four patients underwent bilateral staged PN and one patient underwent simultaneous bilateral PN (horseshoe kidney). Two patients underwent RFA at the time of biopsy of the contralateral mass after PN. Five patients underwent CT-bx/FNA (5/5) of the contralateral mass followed by active surveillance. Mean follow up was 34 months. There was no significant change in median creatinine pre- and post-operatively. One patient was lost to follow up and one patient died of unknown causes 5 years post-operatively. eGFR decreased an average of 16.96% post-operatively, including a single patient whose eGFR increased by 7.8% after surgery and a single patient whose eGFR did not change (Table 2).

CONCLUSIONS

Patients with bilateral renal masses and pathologically proven RO can be safely managed with active surveillance after biopsy confirmation of the contralateral mass.

Contemporary Issues Surrounding Small Renal Masses: Evaluation, Diagnostic Biopsy, Nephron Sparing, and Novel Treatment Modalities

Incidental identification of small renal masses (SRMs) has become increasingly common with widespread adoption of cross-sectional imaging. To date, early detection of SRMs has not translated to a substantial improvement in cancer-specific survival. Guidelines on the management of SRMs are evolving to reflect recent developments in treatment. The major approaches to managing SRMs include active surveillance, partial/radical nephrectomy, and ablative therapies, such as radiofrequency ablation with cryoablation. The goal of treatment is to optimize oncologic and renal function outcomes while avoiding overtreatment and associated morbidity. In this review, we summarize the diagnosis of SRMs, the role of renal mass biopsy, different treatment strategies, and future directions, including emerging molecular biomarkers.