Renal medullary carcinoma: report of seven cases from Brazil

We report seven cases of renal medullary carcinoma collected from several institutions in Brazil. In spite of a relatively high incidence of sickle cell trait in Brazil, this is a rare tumor. All patients were males between the ages of 8 and 69 years (mean 22 years). From the collected information, the most frequent presenting symptoms were gross hematuria and flank or abdominal pain. The duration of symptoms ranged from 1 week to 5 months. Most of the tumors were poorly circumscribed arising centrally in the renal medulla. Size ranged from 4 to 12 cm (mean 7 cm) and hemorrhage and necrosis were common findings. All seven cases described showed sickled red blood cells in the tissue and six patients were confirmed to have sickle cell trait. All cases disclosed the characteristic reticular pattern consisting of tumor cell aggregates forming spaces of varied size, reminiscent of yolk sac testicular tumors of reticular type. Other findings included microcystic, tubular, trabecular, solid and adenoid-cystic patterns, rhabdoid-like cells and stromal desmoplasia. A peculiar feature was suppurative necrosis typically resembling microabscesses within epithelial aggregates. The medullary carcinoma of the 69-year-old patient was associated with a conventional clear cell carcinoma. To our knowledge, this association has not been previously reported and the patient is the oldest in the literature. The survival after diagnosis or admission ranged from 4 days to 9 months. The 8-year-old African-Brazilian patient with a circumscribed mass is alive and free of recurrence 8 years after diagnosis. This case raises the question whether a periodic search for renal medullary carcinoma in young patients who have known abnormalities of the hemoglobin gene and hematuria could result in an early diagnosis and a better survival.

Seminal vesicle invasion in radical prostatectomies: which is the most common route of invasion?

INTRODUCTION

Very few studies have been published on seminal vesicle invasion (SVI), and these have obtained conflicting results. The aim of the present investigation was to determine the most frequent of three possible routes of seminal vesicle invasion: (1) extraprostatic extension (EPE) into soft tissue adjacent to the seminal vesicle and then into the wall of the seminal vesicle, (2) invasion via the sheath of the ejaculatory duct, penetrating the muscular wall of the ejaculatory duct or extending up the ejaculatory duct into the seminal vesicle muscle wall, or (3) discontinuous metastases.

MATERIALS AND METHODS

The surgical specimens of 230 consecutive patients submitted to radical prostatectomy were histologically evaluated by complete embedding and whole-mount processing.

RESULTS

Of the surgical specimens obtained from 230 patients, 28 (12.17%) showed the presence of either unilateral or bilateral SVI. The routes of SVI in these 28 specimens were: (1) only via the sheath of the ejaculatory duct (0/28; 0%); (2) discontinuous metastases (3/28; 11%), (3) both EPE and via the sheath of the ejaculatory duct (6/28; 21%), and (4) only EPE (19/28; 68%). One-half (14/28; 50%) of the 28 seminal vesicles involved had unilateral invasion and, in most of these cases (42.85%), EPE was unilateral and ipsilateral.

CONCLUSION

Our results suggest that the most important and most frequent route of SVI is extraprostatic extension of prostate carcinoma into the soft tissue adjacent to the ipsilateral seminal vesicle and then into the wall of the seminal vesicle.

Extravasation mucocele involving the ventral surface of the tongue (glands of Blandin-Nuhn)

BACKGROUND

Mucocele is a lesion that involves the salivary glands and respective current ducts caused mainly by traumas in the affected area. Two different histological forms can be found: extravasation phenomenon and mucus-retention cyst where the former is the most frequently observed involving minor salivary glands such as the glands present in the anterior portion of the ventral surface of the tongue (glands of Blandin-Nuhn).

CASE REPORT

This report describes a large lesion involving the ventral surface of the tongue that was definitively diagnosed by histological examination as extravasation mucocele.

CONCLUSION

Important concepts are reviewed to help clinicians correctly diagnose and treat this pathology.

Prevention of suicide phenomenon in aeromonads

Clinical isolates of Aeromonas (13 Aeromonas caviae), 8 Aeromonas hydrophila, 3 Aeromonas spp., and 2 Aeromonas media recovered from diarrheal feces of children were submitted to the suicide phenomenon test and investigated at intervals of 24 h for up to 120 h. The same isolates were also stimulated by repeated passages in broth for ten days before the test. After the bacterial stimulus, a decreases in the number of aeromonads with suicidal capacity was observed. The suicide phenomenon was expressed after 72 h of incubation in only some isolates. The results show that the suicide phenomenon can be prevented by stimulation of bacterial metabolism.