Ewing's sarcoma of the urinary bladder - the urologic and pathologic differential diagnosis and current therapeutic options

BACKGROUND

Bladder cancer is 11th most common cancer worldwide. Histologically, most of the tumors are classified as urothelial carcinomas. Less common variants (squamous cell or adenocarcinomas) usually comprise up to 10% of cases. Other types of tumors are exceptional. The finding of Ewing's sarcoma in the bladder is considered extremely rare.

CASE

We present the case of a 54-year-old female patient examined for painless hematuria. During the follow-up examination, a bulky tumor of the bladder was detected, but considering the extent of the bladder tumor, only a diagnostic transurethral resection was possible. According to the primary staging, the disease was already advanced at the time of admission with metastatic spread, anemia and present obstruction of the upper urinary tract.

RESULTS

Histologically, Ewing's sarcoma was surprisingly demonstrated in the urinary bladder. Anemia caused by hematuria and advanced disease was corrected by blood transfusions and obstruction of the right kidney by puncture nephrostomy. However, despite a very quick diagnosis, completion of staging and preparation of the patient for further treatment, the patient had died before the planned systemic treatment began.

CONCLUSION

The diagnosis of Ewing's sarcoma is identical to that of the other bladder tumors, i.e. transurethral resection. In the case of confirmation of this histological type, it is necessary to complete staging examinations and start multimodal treatment. Early systemic chemotherapy plays a key role and if metastatic spread is excluded, radical cystectomy or radiotherapy are included, too. The aim of our communication is to present a rare case of this disease, discuss the differential diagnosis and point out the principles and possibilities of its treatment.

Connecting the data landscape of long-term ecological studies: The SPI-Birds data hub

The integration and synthesis of the data in different areas of science is drastically slowed and hindered by a lack of standards and networking programmes. Long-term studies of individually marked animals are not an exception. These studies are especially important as instrumental for understanding evolutionary and ecological processes in the wild. Furthermore, their number and global distribution provides a unique opportunity to assess the generality of patterns and to address broad-scale global issues (e.g. climate change). To solve data integration issues and enable a new scale of ecological and evolutionary research based on long-term studies of birds, we have created the SPI-Birds Network and Database (www.spibirds.org)-a large-scale initiative that connects data from, and researchers working on, studies of wild populations of individually recognizable (usually ringed) birds. Within year and a half since the establishment, SPI-Birds has recruited over 120 members, and currently hosts data on almost 1.5 million individual birds collected in 80 populations over 2,000 cumulative years, and counting. SPI-Birds acts as a data hub and a catalogue of studied populations. It prevents data loss, secures easy data finding, use and integration and thus facilitates collaboration and synthesis. We provide community-derived data and meta-data standards and improve data integrity guided by the principles of Findable, Accessible, Interoperable and Reusable (FAIR), and aligned with the existing metadata languages (e.g. ecological meta-data language). The encouraging community involvement stems from SPI-Bird's decentralized approach: research groups retain full control over data use and their way of data management, while SPI-Birds creates tailored pipelines to convert each unique data format into a standard format. We outline the lessons learned, so that other communities (e.g. those working on other taxa) can adapt our successful model. Creating community-specific hubs (such as ours, COMADRE for animal demography, etc.) will aid much-needed large-scale ecological data integration.

Infiltration of Prostate Cancer by CD204+ and CD3+ Cells Correlates with ERG Expression and TMPRSS2-ERG Gene Fusion

BACKGROUND

The aim of the study was to detect CD204 + and CD3 + cells in the infiltrate of benign prostatic hyperplasia, prostatic intraepithelial neoplasia and prostatic cancer in prostate specimens after radical prostatectomy. Another goal was to determine correlation of the intensity of the infiltration with ERG oncoprotein expression as well as with the presence of activat-ing translocation TMPRSS2-ERG.

MATERIALS AND METHODS

To confirm the translocation, we used fluorescence in situ hybridization. Imunohistochemistry was used to detect the presence of ERG oncoprotein and for assesment of the number of CD204+ and CD3+ infiltrat-ing cells. We determined the capability to infiltrate malignant structures accord-ing to differences in infiltration of benign and malignant prostate structures.

RESULTS

Biometric analysis confirmed that the number of CD204+ macrophages in the malignant structure was significantly higher than in the benign prostatic hyperplasia regardless of the fusion pattern. Increased infiltration by CD3+ cells was only detected in malignant structures of the prostate in a group with normal signal pattern and in a group with TMPRSS2-ERG fusion. Expression of ERG positively correlated with CD204+ and CD3+ cells infiltration of malignant structures only in cases where the TMPRSS2-ERG fusion was found. In the group with a break in the TMPRSS2 gene, a positive correlation was only found between ERG expression and CD204+ macrophages infiltration. In cases with a normal signal pattern, no correlation was found. In the group with TMPRSS2-ERG fusion we observed significantly more cases with a good capability of CD204+ cells to infiltrate malignant structures, unlike the group with a normal signal pattern, where there were more cases with the weak reactivity of CD204 + cells to infiltrate the malignant structures. The same was observed for CD3+ cells. CD204+ macrophages and CD3+ T-lymphocytes in the group with TMPRSS2-ERG gene fusion, infiltrated the malignant prostate structures more intensely, but their effect on malignant transformation may be different.

CONCLUSIONS

The association between the presence of the TMPRSS2-ERG fusion and the different capability of inflammatory cells to infiltrate malignant structures has not been reported so far. The results confirm the important role of the activated ERG gene, due to TMPRSS2-ERG fusion, in the development of inflammation of the prostate as well as the effect of inflammatory cells on the course of neoplastic process. This leads to considerations about introduc-ing immunomodulatory modalities into prostate cancer therapeutic protocols. Key words: prostate cancer -  TMPRSS2-ERG gene fusion -  ERG -  immune response -  CD204+ macrophages -  CD3+ T-lymphocytes.

Sympatric divergence and clinal variation in multiple coloration traits of Ficedula flycatchers

Geographic variation in phenotypes plays a key role in fundamental evolutionary processes such as local adaptation, population differentiation and speciation, but the selective forces behind it are rarely known. We found support for the hypothesis that geographic variation in plumage traits of the pied flycatcher Ficedula hypoleuca is explained by character displacement with the collared flycatcher Ficedula albicollis in the contact zone. The plumage traits of the pied flycatcher differed strongly from the more conspicuous collared flycatcher in a sympatric area but increased in conspicuousness with increasing distance to there. Phenotypic differentiation (PST ) was higher than that in neutral genetic markers (FST ), and the effect of geographic distance remained when statistically controlling for neutral genetic differentiation. This suggests that a cline created by character displacement and gene flow explains phenotypic variation across the distribution of this species. The different plumage traits of the pied flycatcher are strongly to moderately correlated, indicating that they evolve non-independently from each other. The flycatchers provide an example of plumage patterns diverging in two species that differ in several aspects of appearance. The divergence in sympatry and convergence in allopatry in these birds provide a possibility to study the evolutionary mechanisms behind the highly divergent avian plumage patterns.

Endovascular treatment of acute basilar artery occlusion: time to treatment is crucial

AIM

To evaluate the safety and efficacy of multimodal endovascular treatment (EVT) of acute basilar artery occlusion (BAO), including bridging therapy [intravenous thrombolysis (IVT) with subsequent EVT], to compare particular EVT techniques and identify predictors of clinical outcome.

MATERIALS AND METHODS

This retrospective, multi-centre study comprised 72 acute ischaemic stroke patients (51 males; mean age 59.1 ± 13.3 years) with radiologically confirmed BAO. The following data were collected: baseline characteristics, risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, localization of occlusion, time to therapy, recanalization rate, post-treatment imaging findings. Thirty- and 90-day outcomes were evaluated using the modified Rankin scale with a good clinical outcome defined as 0-3 points.

RESULTS

Successful recanalization was achieved in 94.4% patients. Stepwise binary logistic regression analysis identified the presence of arterial hypertension (OR = 0.073 and OR = 0.067, respectively), National Institutes of Health Stroke Scale (NIHSS) at the time of treatment (OR = 0,829 and OR = 0.864, respectively), and time to treatment (OR = 0.556 and OR = 0.502, respectively) as significant independent predictors of 30- and 90-day clinical outcomes.

CONCLUSION

Data from this multicentre study showed that multimodal EVT was an effective recanalization method in acute BAO. Bridging therapy shortens the time to treatment, which was identified as the only modifiable outcome predictor.

[Shoulder arthrodesis using an external fixator in the treatment of chronic inflammatory complications of proximal humeral fractures]

INTRODUCTION

Chronic osteomyelitis is a serious chronic condition that frequently results in permanent after-effects. Treatment is complex, lengthy and costly.

MATERIAL AND METHODS

Between the beginning of 2003 and the end of 2010, 438 operations of the proximal humerus were performed at our department using either angle-stable osteosynthesis or hemiarthroplasty. In four cases out of this group of patients, deep tissue infection affecting the bone developed. These four patients were treated with arthrodesis of the shoulder joint using an external fixation device. Arthrodesis was also the treatment method in a patient who previously received conservative treatment but developed chronic osteomyelitis.

RESULTS

Healing of the infectious focus along with the formation of stable, painless shoulder was achieved in all five patients, with the arthrodesis offering full support for the limbs periphery.

CONCLUSION

The above method represents an alternative to reverse arthroplasty of the shoulder joint usually performed after infection is cured. While function of the limb usually worsens after arthrodesis, the risk of recurring inflammation is substantially lower.

Predictors of good clinical outcome in acute stroke patients treated with intravenous thrombolysis

OBJECTIVES

Intravenous thrombolysis (IVT) is considered an effective treatment for acute ischemic stroke (IS). However, not all treated patients may achieve good outcome. The aim was to evaluate whether the initial NIHSS and DWI infarct volume could be the predictors for good outcome after IVT.

PATIENTS AND METHODS

The set of 125 patients with consecutive hemispheric IS (78 men; mean age 66.0 ± 12.1 years) treated with IVT within 3 h was analyzed. DWI volume was measured on admission. Good outcome was defined as a score 0-2 in modified Rankin Scale.

RESULTS

Multivariate logistic regression analysis showed initial NIHSS as an independent predictor of good outcome (P = 0.001). ROC curves showed baseline NIHSS ≤13.5 points and DWI volume ≤13.7 ml as cut-offs related to good outcome.

CONCLUSIONS

The initial NIHSS and DWI volume might be the predictors for good clinical outcome in acute stroke patients treated with IVT. The initial NIHSS score seems to be more accurate.

Thrombolytic treatment of ischaemic stroke occurring during a migrainous attack: a case report

Authors report a case of young female suffering from the acute ischaemic stroke with right-sided hemiplegia, hemianopsia and hemihypoaesthesia during a migrainous attack without aura. Magnetic resonance imaging detected infarction in the left occipital lobe and occlusion of branches of the posterior cerebral artery (PCA). Combined treatment with systemic thrombolysis and sonothrombolysis was used, leading to the early PCA recanalization, and to a favourable clinical outcome after 1 month. Intravenous thrombolytic treatment administered within the therapeutic window may be useful in cerebral ischaemia associated with migraine when an arterial occlusion is documented.

Occurrence of diabetes mellitus in spontaneous intracerebral hemorrhage

The role of diabetes mellitus (DM) in the etiopathogenesis of spontaneous intracerebral hemorrhage (SICH) is controversial. The aim was to assess the role of DM in our SICH patients. In a hospital-based cross-section study, the occurrence of DM prior to a hemorrhagic stroke was observed in 80 SICH patients (44 males, aged 36-87 years, mean 67.1 +/- 11.9 years; 36 females, aged 56-86 years, mean 71.1 +/- 8.3 years), and in a control group (CG) of 80 age- and sex-matched patients with low back pain. All patients were treated at the Departments of Neurology and Neurosurgery, University Hospital, Olomouc, Czech Republic. Two-sample t test and Pearson's homogeneity chi(2) test were applied when assessing statistical significance. DM was found in 37.5% of SICH patients versus 22.5% of CG subjects (P < 0.05). DM occurs significantly more frequently in SICH patients in the Olomouc region of the Czech Republic when compared to the general population.

[Hemiarthroplasty for management of proximal humeral fractures]

PURPOSE OF THE STUDY

With the advent of angle-stable implant systems in surgical treatment of proximal humeral fractures, the number of indications to shoulder hemiarthroplasty decreased dramatically, because these modern implants provide certain fixation of osteoporotic bone fragments in elderly patients.

MATERIAL AND METHODS

The authors report on their experience with shoulder replacement surgery in 29 patients, of which 26 underwent urgent surgery. The indications for acute hemiarthroplasty included humeral head fractures in which destruction of the articular surface exceeded 40 %, and fractures with evident or suspected insufficient vitality of the humeral head in elderly patients. Other indications included intra-operative osteosynthesis with the necessity of subsequent intra-operative conversion. Two patients with late implant failure and one with bone malunion, after conservative treatment of a fracture, were indicated for second stage hemiarthroplasty. The authors draw attention to the most frequent errors associated with this surgery and describe guidelines used in post-operative care. A total of 20 patients were evaluated by the Constant Score at an average follow-up of 12.5 months (range, 6-39 months).

RESULTS

Shortly after the operation, loosening of parts of the modular prosthetic system occurred in two patients. Aseptic loosening of the stem was observed in two patients, and early deep wound infection was found in two patients. The implant was removed in two cases, once for its loosening, and once for persisting infection. None of the patients died due to causes related to shoulder hemiarthroplasty. The functional outcomes corresponded to the choice of patients, because the indications for hemiarthroplasty involved the most serious fractures in elderly patients. Post-operative subjective evaluation usually showed only intermittent and mild pain; only four patients complained of severe pain. Arm elevation in the youngest age group, i.e., up to 59 years, was 100 degrees on the average, with a range of 70 to 140 degrees. In the patients 60 to 69 years old, the average elevation was 95 degrees, with a range of 90 to 110 degrees; in the oldest group, i.e., 70 years and older, the average elevation was 75 degrees and the range was 30 to 130 degrees. Excellent outcomes with elevation over 120 degrees were achieved in four patients only. The average Constant Scores in the three age groups were 68, 54 and 42 points, respectively.

DISCUSSION

When deciding the indications for hemiarthroplasty, many factors must be considered. Beside the type of fracture and patient's age, a possible impairment of blood supply, which is associated with avascular bone necrosis, must also be taken into account. Criteria for correlation between vascularisation impairment and X-ray findings, with the analysis of advantages and disadvantages of hemiarthroplasty, are described in this article. In the end, an indication scheme for the treatment of proximal humeral fractures is suggested.

CONCLUSIONS

Good results achieved in shoulder hemiarthroplasty are related to both the development of modular prosthetic systems for shoulder replacement and a faultless surgery procedure itself. Careful and long-term post-operative care also plays an important role. Functional outcomes after acute hemiarthroplasty are clearly better than those after a second-stage operation performed when conservative treatment or previous osteosynthesis have failed.