Unusual semi-spheric perivesical calcification after pelvic radiotherapy.
An uncommon case with semi-spheric perivesical calcification after pelvic radiotherapy is reported and the possible pathogenesis of this phenomenon is discussed.
Calcinosis↗
Biomedical subjects
A Manseck
Publications and source records attributed to A Manseck.
Locally recurrent malignant fibrous histiocytoma: a rare and aggressive genitourinary malignancy.
OBJECTIVE: In this study, 22 cases of locally recurrent urological malignant fibrous histiocytoma were reviewed considering therapeutic options, follow-up and prognosis. PATIENTS AND METHODS: In the available literature on this topic we identified 19 cases of locally recurrent genitourinary malignant fibrous histiocytoma. Three additional cases are discussed, primarily arising from the kidney, the bladder and the paratesticular region. RESULTS: The prognosis of locally recurrent urological malignant fibrous histiocytoma was found to be extraordinarily poor. Only 2 of 22 patients have survived for longer than 3.5 years. One of them reported herein is still alive 10 years after extensive lymphatic spread accompanying the first local recurrence. In this case, late local recurrence occurred after an 8-year interval free of disease. CONCLUSION: Malignant fibrous histiocytoma is an unusual urological malignancy with a high rate of local recurrence. The latter is frequently accompanied by metastatic disease and unrelenting progression. Despite the poor prognosis early detection of local failure and aggressive salvage therapy might offer the chance of long-term survival in selected cases. Close and life-long follow-up is advisable for patients once treated for recurrent urological malignant fibrous histiocytoma.
Aged↗
[What should be done in positive margins after radical prostatectomy?].
In the last years radical retropubic prostatectomy has become the treatment of choice for locally confined prostate cancer (PCa). However, in the literature local recurrence is described in 4-23% of patients with clinical stage T1-2 prostate cancer and in 43% of patients with clinical stage T3 respectively. The problem is further aggravated that postoperatively raised PSA values are detected in 6-8% of patients with locally confined prostate cancer indicating either local residual tumor or systemic disease. Current datas show that wait-and-watch appears to be the best option for patients with locally confined prostate cancer and positive margins. In case of persistent or raising PSA-values following prostatectomy without detectable local recurrence or metastasis mere local therapy cannot be recommended. Primary radiotherapy should be considered in cases with confirmed clinical local recurrence without distant metastasis. Further prospective and randomized trials have to be initiated to identify the patients with positive margins who will benefit from adjuvant treatment.
Biomarkers, Tumor↗
Splenunculus mimicking late local recurrence of renal cell carcinoma.
We report on a case of a splenunculus found in the renal fossa 14 years after left transperitoneal radical nephrectomy and splenectomy for renal cell carcinoma. The significance of splenunculi in differential diagnosis of space occupying lesions in the left renal bed is discussed.
Carcinoma, Renal Cell↗
Diagnostic significance of prostate-specific antigen velocity at intermediate PSA serum levels in relation to the standard deviation of different test systems.
Serial prostate-specific antigen (PSA) measurements (PSA velocity) as an additional instrument to detect prostatic cancer was introduced in 1992. It has previously been reported that PSA increase per year differed in the last 5 years prior to diagnosis in patients with benign prostatic hyperplasia (0.18 ng/ml/year), locally confined (0.75 ng/ml/year) and metastasized (4.4 ng/ml/year) cancer of the prostate (CaP) in contrast to healthy men (0.04 ng/ml/year). The ability of PSA velocity to detect organ-confined CaP in patients with intermediate PSA serum values depends therefore on a reliable and reproducible PSA result. The present study comprised 85 men with PSA values between 3 and 8 ng/ml (Abbott IMx). PSA measurements were repeated with Abbott IMx (n = 85 patients) and Hybritech Tandem-E (n = 59 patients) assays. The PSA serum values differed from one examination to the other from 0.02 to 2.74 ng/ml with the Abbott IMx. Standard deviation amounted to 0.35 ng/ml with the Abbott IMx PSA assay. Using the Hybritech Tandem-E assay, mean standard deviation was 1.15 ng/ml and therefore higher than with the Abbott IMx assay. The difference from one test to the other ranged from 0.05 to 4.05 ng/ml with the Hybritech Tandem-E. Using the Abbott IMx assay, 10.6% of all repeat measurements exceeded 1 ng/ml whereas in the Hybritech Tandem-E assay 62.7% of the second measurements differed > 1 ng/ml from the first PSA result. An increase in PSA serum values may therefore be due to intratest variation, physiological day-to-day variation as well as prostatic disease. It is important to notice that the intra-assay variation may be greater than the PSA increase per year in a patient with CaP. Therefore, PSA velocity seems to be of limited value.
Adult↗
Late local and pulmonary recurrence of renal cell carcinoma.
Locally recurrent renal cell carcinoma and multiple pulmonary metastases were successfully resected in a patient 20 years after nephrectomy.
Carcinoma, Renal Cell↗
[Screening in prostate carcinoma].
With an increasing incidence, prostate cancer has become the most common cancer in males in the USA. In Germany, 20,000 new cases of prostate cancer were detected in 1995. Only organ confined prostate cancer is curable. Therefore the main intention of screening is an increasing detection rate of clinically significant tumors in time. Cancer specific mortality and morbidity should be decreased by screening. Whether screening can actually achieve this has to be proven in prospective randomized trials, which have only been started recently. Therefore, valid results cannot be expected before the year 2007. Different trials revealed the combination of digital rectal examination and the measurement of prostate specific antigen to be the most useful tools in screening at present. In conclusion, at present, the recommendation is an urological examination once a year in men from 45-50 (depending on risk) to 70-75 years of age--if the patient agrees to the possible diagnostic and therapeutic consequences.
Adult↗
[Value of PSA density determination in prostate carcinoma].
The PSA density was calculated in 98 patients with carcinoma of the prostate by using the weight and/or volume of the radical prostatectomy specimen. In 22 of 98 patients, PSA serum levels ranged between 4 and 10 ng/ml. Eleven patients showed PSA serum levels below 4 ng/ml and 65 patients above 10 ng/ml. Sixty-one of the 65 patients with PSA serum levels > 10 ng/ml had PSAD values above 0.15, and we therefore suspected the presence of carcinoma of the prostate according to Benson et al. Twelve of the 22 patients with PSA serum levels between 4 and 10 ng/ml had PSAD values below the cut-off value of 0.15. In addition, all 11 patients with PSA values < 4 ng/ml showed PSAD values < 0.15, a range that can be regarded as almost harmless according to Benson et al. In conclusion, it seems apparent that in patients with PSA serum levels < 10 ng/ml, no important additional information is obtained from the PSAD determination. Routine measurement of PSAD for evaluating the risk of carcinoma of the prostate in individual cases can therefore not be recommended.
Adult↗
[Primary renal plasmacytoma. A case report].
We describe a patient with a primary renal plasmacytoma. In the literature available, only six clinical cases have been reported. A 64-year-old patient is presented who had the clinical signs of a renal cell carcinoma. Histological examination after nephrectomy, however, revealed a plasmacytoma. Based on this case, we discuss how one should proceed in this disease. Primary renal plasmacytoma can be tentatively diagnosed preoperatively only in the presence of paraproteinemia or Bence-Jones proteinuria, as it cannot be distinguished from other renal tumors by imaging procedures. Postoperatively, further staging procedures must rule out bone involvement (solitary myeloma or multiple myeloma). Nephrectomy is required in patients with plasmacytoma only if renal complications occur.
Carcinoma, Renal Cell↗
Prognostic significance of capsular invasion and capsular penetration in patients with clinically localized prostate cancer undergoing radical prostatectomy.
One hundred thirty patients with an observed follow-up of more than 10 years after radical prostatectomy were restaged with regard to local extent of the tumor in relation to the prostate capsule. Of 112 patients with surgically staged negative pelvic lymph nodes, 62 had a tumor-free prostate capsule, 24 had capsular invasion without penetration, and 26 had tumors extending through the capsule of the prostate. Observed overall and disease-free 10-year-survival rates were 79% and 69.4%, respectively, in patients with absence of capsular involvement and 70.8% and 66.7%, respectively, in patients with capsular invasion alone. In patients with capsular penetration, however, the survival rates significantly decreased to 57.7% (P = 0.018) and to 38.5 (P = 0.017), respectively. The overall progression rate was found to be significantly higher in patients with tumors extending through the prostatic capsule (46.2%), as compared to those with absence of capsular involvement (21%; P = 0.014) as well as to those with capsular invasion alone without penetration (25%; P = 0.034). Thus, in contrast to capsular invasion alone, capsular penetration means a poor prognostic indicator, which accounts for a reduced survival expectancy and a higher progression rate following radical prostatectomy. Therefore, tumors with capsular invasion and those with capsular penetration should not be grouped together in the same tumor stage as done in the 1987 edition of the TNM tumor classification system.
Adult↗
Survival and quality of life of patients with stage D1 (T1-3 pN1-2 M0) prostate cancer. Radical prostatectomy plus androgen deprivation versus androgen deprivation alone.
A series of 139 patients with histologically proven stage D1 (T1-3 pN1-2 M0) prostate cancer was reviewed in order to determine the influence of radical surgery in addition to hormonal treatment on long-term outcome with respect to survival and quality of life. In all 139 patients a pelvic lymphadenectomy was performed. In 87 patients, lymphadenectomy was followed by androgen deprivation alone (group 1). Fifty-two patients underwent additional radical prostatectomy (group 2). The actuarial 10-year nonprogression rates were 14.6% in group 1 and 35.8% in group 2, respectively (p = 0.0016). The overall and disease-specific 10-year survival rates were found to be 29.7 and 32.1%, respectively, for group 1 and 50.8 and 70.7%, respectively, for group 2. Local progression as the main parameter influencing quality of life occurred in 60 of the 87 patients (69%) not subjected to radical prostatectomy. Transurethral resection of the prostate was required in 29 of these patients. In contrast, following radical prostatectomy, only 4 of the 52 patients (8%) had local progression and only 1 patient (2%) needed a dilatation of the vesicourethral anastomosis for relief of infravesical obstruction. Thus, radical prostatectomy plus androgen deprivation for patients with stage D1 prostate cancer appeared to be superior to androgen deprivation alone with respect to survival expectancy and quality of life. Prospective randomized trials, however, have to be undertaken to verify these results.
Biopsy↗
Malignant neurofibroma of the urinary bladder.
We report a case of a large malignant neurofibroma of the urinary bladder occurring in a 33-year-old patient with Recklinghausen's neurofibromatosis. Urologic manifestations of neurofibromatosis are infrequent; a neurofibroma of the bladder with malignant degeneration is an extreme rarity. To date only 3 cases have been described in the literature.
Adult↗
DNA-ploidy, G2M-fractions and prognosis of stages B and C prostate carcinoma.
Paraffin embedded tissue of 49 stage C and 27 stage B prostate adenocarcinomas was investigated by flow cytometry. All patients were treated by radical prostatectomy with pelvic lymphadenectomy and followed up for 5-10 years. The tumour was separated from the benign tissue to increase the proportion of tumour cells. Ten stage C and seven stage B carcinomas had to be excluded because of poor fixation. Six of the 39 (15%) stage C and 1/20 (5%) stage B carcinomas were aneuploid. Cell cycle analysis was done with correction for sliced nuclei and background subtraction. The threshold between carcinomas with low and with increased ("tetraploid") G2M-fraction was determined by comparing carcinomas with and without tumour progression. Sixty-seven percent of the patients with non-euploid stage C carcinomas and 11% of those with euploid carcinomas suffered from tumour progression (P < 0.01). The respective values for the stage B carcinomas were 67% and 6% (P < 0.01). These results demonstrate the strong prognostic impact of DNA-ploidy and G2M-fractions for each individual patient.
Adult↗
Radical prostatectomy in patients with incidental prostate carcinoma.
Radical prostatectomy was carried out in 30 patients with an incidental carcinoma of the prostate. A tumor stage T1a (A1) was present in 7 cases and a tumor stage T1b (A2) in 23 cases. None of the 30 patients died postoperatively. As intraoperative complication, a rectum perforation occurred in 1 case. In the 23 patients with a T1b tumor, a pT2pN0M0 lesion was found in 10 cases and pT3pN0M0 lesion in 11 cases on pathohistological examination after radical prostatectomy. In 5 out of 30 patients the carcinoma could no longer be detected in the radical prostatectomy specimen. In 1 patient with a T1a tumor, pelvic lymphadenectomy revealed a single lymph node metastasis. Tumor progression did not occur in any of the 7 patients with a T1a tumor after an observation period of 9 months up to 16 years (average 4.6 years). The percentage of progression-free patients in stage T1b was calculated as 81.4% 10 years after surgery. The calculated overall survival time of patients in stage T1b was 76.3% after 10 years and the tumor-related survival was 87.5%.
Actuarial Analysis↗
Value of prostate-specific antigen as a tumor marker.
Prostate-specific antigen (PSA) is the most important tumor marker for prostate cancer. However, the diagnostic limits of PSA have to be taken into consideration because PSA is also secreted by normal prostate tissue and, with benign prostatic hyperplasia, false positives are possible. Although there is a direct correlation between the serum PSA concentration and the clinical stage of the tumor, PSA is not sufficiently reliable to determine the stage of the disease on an individual basis. Low serum PSA concentrations (less than 20 ng/ml) in patients with previously untreated prostate cancer seem to be predictive for a negative bone scan. Serum PSA values also reflect the prognosis of the patient. With respect to monitoring patients after definitive therapy, PSA is a very sensitive tumor marker. However, in a small number of patients PSA-negative tumor recurrences occur.
Humans↗
[Immunotherapy of metastatic renal cell cancer].
In the treatment of advanced renal cell carcinoma, cytokines such as interferons, interleukin-2, tumor necrosis factor and immune therapy with autologous tumor cells and tumor cell vaccines have been tested on a large scale. A definitive cure of a patient with advanced renal cell cancer treated with cytokines or immune therapy has so far not been reported in the literature. The rates of objective remissions (PR and CR) are disappointing and rarely exceed 20% overall. The combination of interferon-alpha and interleukin-2 administered subcutaneously seems to offer the best results with the lowest morbidity. However since standard treatment protocols do not exist, treatment of patients with renal cell carcinoma using these substances should only be performed in prospective trials. Immunotherapy with interferons, interleukin-2, tumor necrosis factor, autologous tumor cells or tumor cell vaccines has to be regarded as experimental.
Carcinoma, Renal Cell↗
[Value of transrectal ultrasound in determining the T-stage of prostate cancer].
Accurate preoperative staging of prostate adenocarcinoma is especially important before radical prostatectomy. The purpose of this prospective study was to investigate the staging accuracy of transrectal ultrasonography in prostatic adenocarcinoma. The results of the preoperative staging evaluation in 126 patients with endorectal ultrasound were compared with the histopathologic findings after radical prostatectomy. Correct staging by transrectal sonography was possible in 82 of 126 patients (65%). For stage pT3 tumors, sensitivity, specificity and positive predictive value were 69%, 51% and 82% respectively.
Adult↗
Value of nuclear DNA ploidy patterns in patients with prostate cancer after radical prostatectomy.
Flow cytometric analysis of DNA ploidy was performed on prostatic adenocarcinoma specimens from 80 patients. In all these patients a radical retropubic prostatectomy had been performed. The nuclei for DNA ploidy determination were extracted from paraffin-embedded material of whole sections of the prostate from patients treated by radical prostatectomy between 1980 and 1985. DNA ploidy was a strong prognostic indicator independent of tumor grade and tumor stage. DNA ploidy offered additional information on both tumor stage and tumor grade. In stage C disease the likelihood of progression-free survival was 89.5% in diploid tumors and 27.8% in aneuploid tumors after 9 years. In tetraploid tumors all patients progressed after 9 years. The computed survival rates in stage C disease showed that patients with diploid tumors did significantly better than those with aneuploid or tetraploid tumor patterns. These data indicate therefore that DNA ploidy patterns determined by flow cytometric analysis provide important additional prognostic information on prostatic adenocarcinoma treated by radical prostatectomy.
Adenocarcinoma↗