Biomedical subjects
Publications and source records attributed to A Houlgatte.
The great variety of non germinal testis tumours and their rarity explain the difficulties of a specific therapeutic management. The analysis of the most important varieties of tumours allows identifying an overall trend in both diagnosis and therapy.
We investigated whether genetic lesions such as loss of heterozygosity (LOH) are detected in prostatic cells obtained by prostatic massage during early diagnosis of prostate cancer (CaP) and discussed their clinical relevance. Blood and first urine voided after prostatic massage were collected in 99 patients with total prostate-specific antigen (PSA) between 4 and 10 ng ml(-1), prior to prostate biopsies. Presence of prostatic cells was confirmed by quantitative RT-PCR analysis of PSA mRNA. Genomic DNA was analysed for LOH on six chromosomal regions. One or more allelic deletions were found in prostatic fluid from 57 patients analysed, of whom 33 (58%) had CaP. Sensitivity and specificity of LOH detection and PSA free to total ratio <15% for positive biopsy were respectively 86.7 and 44% (P=0.002) for LOH, and 55 and 74% (P=0.006) for PSA ratio <15%. Analysis of LOH obtained from prostatic tumours revealed similar patterns compared to prostatic fluid cells in 86% of cases, confirming its accuracy. The presence of LOH of urinary prostatic cells obtained after prostatic massage is significantly associated with CaP on biopsy and may potentially help to identify a set of patients who are candidates for further prostate biopsies.
Among germ cell tumours, seminomas hold a particular status related to their radio-sensitivity. Although radiotherapy remains the best treatment for Localized tumours of stage 1, in some cases, surveillance or chemotherapy may presently be considered as alternative therapies. Due to Long-term radiotherapy-related adverse effects, in particular the risk of second non-germ malignancies or cardiac morbidity, both dose and irradiation field are reduced in case of lymphatic retroperitoneal extension. Chemotherapy is the preferential treatment in more advanced stages, either with retroperitoneal bulky disease or with metastatic extension. Its efficacy allows Limiting surgical indications on residual masses, relying partly on the follow-up data of positron emission transaxial tomography assessment.
Foreign bodies in the bladder and urethra have been already largely described either by their nature itself as well as by the circumstances of their introduction. If their presence often reveals dubious psychiatric behaviours, one must also evoke possible accidental introductions during transvesical surgery or migration from spaces adjacent to the bladder. The treatment of those foreign bodies can be sorted out through endoscopy or surgical approach.
INTRODUCTION: Seminoma accounts for about 40% of germ cell tumours of the testicle. In this retrospective analysis, we review literature concerning management of stage I seminoma. MATERIALS AND METHODS: Between March 1987 and April 2001, 65 patients with stage I pure testicular seminoma received adjuvant radiotherapy with a 25 MV linear accelerator. RESULTS: Median age was 33 years. Testicular tumour has been found on the right testis in 39 patients and on the left one in 24 patients. Patients have been treated using an anterior-posterior parallel pair and have received 20-25 Gy in 10-14 fractions. The target volume consisted of paraaortic, and paraaortic + homolateral iliac lymph nodes in 17 and 46 patients, respectively. Acute toxicity was mainly digestive, 38% of patients presenting nausea and vomiting. Median follow-up time was 37 months. All patients are alive in complete remission. DISCUSSION: Because of good radio-sensitivity of seminoma, radiotherapy is regarded as standard adjuvant treatment (5 years relapse rate: 3-5%). Acute toxicity is dominated by moderate gastro-intestinal side effects. Secondary neoplasia represents one of the worst possible long-term complications of therapy. Waiting for ongoing randomised trials, the modern literature for seminoma reflects a trend toward lower radiation doses (20-25 Gy) and smaller treatment volumes (paraaortic field). Adjuvant chemotherapy with two courses of carboplatin, might be equivalent to radiotherapy but must be investigated in randomised trials. A surveillance policy is one of the other management options less recommended.
The authors report two cases of adenocarcinomatous dedifferentiation of a recurrent mature teratoma arising 3 and 20 years after the initial resection. This is a rare event, occurring after macroscopically or microscopically incomplete resection of a mature teratoma. The nature of this recurrence was difficult to determine prior to histological examination. However, PET scan suggests the diagnosis of malignant teratoma in the presence of increased uptake by the lesion. These tumours have a poor prognosis. Treatment consists of complete resection of the tumour mass. The possibility of long-term malignant dedifferentiation of a teratoma therefore requires prolonged and regular life-long surveillance of patients presenting a mature teratoma after chemotherapy for non-seminomatous germ cell tumour of the testis.
The authors report two cases of papillomatous squamous carcinoma of the bladder unrelated to schistosomiasis. Both patients were treated by endoscopic resection. The staging assessment comprised thoraco-abdominopelvic computed tomography. A papillomatous squamous carcinoma of the bladder was detected in both cases: one was classified as pT2 G1 N0 M0 and the other as pT1 G1 N0 M0. Recurrence was rapidly observed, at the first follow-up cystoscopy. The tumour initially classified as pT1 subsequently underwent transformation to sarcomatoid carcinoma with peritoneal metastases. Papillomatous squamous carcinoma of the bladder, a rare squamous cell carcinoma, is a well differentiated tumour with an exclusively local and regional development. The prognosis is determined by the degree of tumour invasion, with a high local recurrence rate. The prognosis of invasive tumours is identical to that of conventional squamous cell carcinoma. Therapeutic management is poorly defined, but the only curative treatment appears to be radical cystectomy.
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We report the case of a 25-year-old man who presented a fibrous pseudotumor of the epididymis, a rare focal location of nodular and diffuse fibrous proliferation. We provide the ultrasonographic and MRI findings with pathologic correlation.
Standard chemotherapy of transitional cell carcinoma of the bladder is actually the combination of cisplatine, methothrexate, vinblastine and doxorubicine (MVAC). Although a high response rate, long term survival are rarely observed. More effective agents without toxicity are necessary. Several agents have demonstrated activity alone or in combinations. Combinations regimens use, paclitaxel, gemcitabine and Gallium nitrate, who prove activity alone or in combination with cisplatine or carboplatine, with a response rate of 40 to 70% in patient with visceral localisations. The optimal regimen is not yet determined.
Since priapism is uncommon, treatment is controversial and difficult. In this article we describe a practical, well-documented approach for management of priapism in countries with a high incidence of sickle cell disease. This approach is based on our experience including a total of 56 black patients (49 adults and 7 children) as well as on the results reported in the literature. The patients in our series were examined and treated by the same physician over an 18 year period in various African countries, i.e., Burkina (n = 8), Chad (n = 12), Gabon (n = 19), and Niger (n = 17). Etiologies and pathophysiology are reviewed. In all cases, surgical treatment involved diversion from corpora cavernosa. In the 51 cases with follow-up periods of 3 months or longer, results were considered as excellent in 17 cases (33 p. 100), partial in 5 (9.8 p. 100), and unsuccessful in 29 (56.8). Since 1984, needle drainage with a unilateral transglandular cavernosal-spongiosum shunt based on the technique described by Al Ghorab's has led to better results with immediate detumescence in 80 p. 100 of cases and a long-term success rate of 52 p. 100 (13/25 cases with sufficient follow-up). Except in cases involving sickle cell anemia in which concomitant medical treatment of priapism can be useful, immediate surgical treatment is the only technique effective in avoiding secondary impotence, which was common in our series (58.6). Our p. 100 needle drainage technique appears to be the method of choice for simplified achievement of a unilateral transglandular cavernosal-spongiosum shunt.
Surveillance is one of the options proposed in the management of stage 1 non-seminomatous germ cell tumours when there is only a low risk of progression. No consensus has yet been reached concerning the modalities of this surveillance and several protocols are available, including the CCAFU protocol. The presence of recurrences in this population at low risk of progression, estimated to be 5%, accounts for the continuing research for more precise predictive factors of occult metastases. Although several studies appear to indicate a useful predictive value for some of these factors, their application in clinical practice still appears to be difficult. PET metabolic imaging (positron emission tomography) could constitute a new approach to staging of these tumours, allowing the detection of tumour sites by an increase of carbohydrate metabolism of malignant cells. However, no study is yet available to define the real place of this technique.
We report a translocation (X;1)(p11.2;q21) associated with a nontubulopapillary renal cell carcinoma in a 23-year-old woman. To our knowledge this the first report of such an association. A review of the previously published cases of renal cell carcinoma with t(X;1) and its cytogenetic variants with Xp11.2 anomalies is included. The role of this karyotype abnormality as a clinical marker is discussed. The Xp11.2 abnormality could be a primary abnormality characterizing a particular type of RCC appearing in children and young adults of both sexes and in which the histological aspect is not specific.
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Benign neurogenic tumours originating from lumbar plexus or roots are rare. Two cases are reported. Resection, often possible with another localisation, may result in neurological deficit in these cases. Enucleation, the best choice, is not always feasible. Hollowing-out is therefore a procedure worth understanding.
OBJECTIVE: To compare three immunoassays for total prostate specific antigen (tPSA), free PSA (fPSA), free-to-total PSA ratio (f/tPSA), and the f/tPSA thresholds for optimal differentiation between benign prostatic hypertrophy (BPH) and prostate cancer in 141 consecutive patients referred for prostatic disease. PATIENTS AND METHODS: The study included 43 patients with prostate cancer and 98 with BPH, all confirmed histologically. PSA levels were assessed using the following assay kits just before histological analysis of the prostate; Hybritech (Tandem-R PSA, normal values, NV, < 4 ng/mL, and Tandem-R free PSA), Cis Bio (PSA-RIACT, NV < 2.5 ng/mL and fPSA-RIACT) and Immunocorp (PSA-IRMA, NV < 4 ng/mL and Free PSA-IRMA). The results were assessed to determine the sensitivity, specificity and threshold values of the different assays to differentiate patients with BPH and cancer. RESULTS: The mean tPSA and f/tPSA ratio were statistically different in assays with different NVs. The mean fPSA values differed significantly between the Hybritech and Cis Bio, between the Hybritech and Immunocorp but not between the Cis Bio and Immunocorp assays. With receiver operator curve analysis, there were no statistically significant differences among the three immunoassays in f/tPSA (0.72 for Hybritech, 0.73 for Cis Bio and 0.64 for Immunocorp) or between the tPSA and fPSA curves for each manufacturer. With the sensitivity fixed at 90%, different f/tPSA thresholds were defined (0.22, 0.34 and 0.25 for Hybritech, Cis Bio and Immunocorp, respectively). The specificities (i.e. the percentage of unnecessary biopsies spared) were 22%, 21% and 31%, respectively (not significantly different). CONCLUSION: Each immunoassay could be used to distinguish prostate cancer and BPH at different f/tPSA thresholds, with 21-30% of unnecessary biopsies spared. There was no difference in overall performance among the different assays. Further studies are needed to better define the exact use of the f/tPSA ratio in the routine diagnosis of prostate cancer.
Solitary fibrous tumours constitute a rare disease, which has never previously been described in the seminal vesicles. We report a case of solitary fibrous tumour of the right seminal vesicle in a 53-year-old man. The diagnosis of seminal vesicle tumour was based on transrectal ultrasonography and MRI. The histological diagnosis was established after surgical resection of this tumour. The small biopsy samples and the heterogeneous appearance of these lesions make it difficult to establish the diagnosis on biopsies alone. The surgical attitude to solitary fibrous tumour of the seminal vesicle depends on the clinical features and the course of the lesion.