Successful management of chromophobe type renal cell carcinoma in pregnancy.
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Adult↗
Biomedical subjects
Haluk Ozen
Publications and source records attributed to Haluk Ozen.
Prevalence of lower urinary tract symptoms in a community-based survey of men in Turkey.
AIM: The aim of the present study was to determine the frequency of lower urinary tract symptoms (LUTS), assess the impact of LUTS on quality of life (QOL) and compare the results with recent reports from other population-based studies. METHODS: A total of 266 men participated in the study. The men were stratified into 10-year age groups between 40 and 79 years. All participants were asked to complete a questionnaire that included a Turkish translation of the International Prostate Symptom Score (IPSS) with QOL questions, and void into a uroflowmeter to obtain voided urine volume, peak and mean flow rate. RESULTS: While 14.8% of men had no symptoms (IPSS = 0), 24.9% had moderate to severe symptoms (IPSS> 7). Severity of symptoms increased with age (P = 0.0018). There was a strong relationship between bother score and IPSS (rs = 0.79, P = 0.0001). Fifty-five percent of moderately symptomatic and 78% of severely symptomatic men reported poor QOL (QOL score >/= 3). The results of the survey provide a general picture of the symptomatology and urinary flow profiles of elderly men living in Turkey. CONCLUSION: The prevalence of LUTS in the Turkish community is fairly high, it increases with age and has an impact on QOL that is not negligible.
Adult↗
Telomerase activity in diagnosis of bladder cancer.
OBJECTIVE: Telomerase is an enzyme that can reconstitute the ends of chromosomes after cell division and thus circumvent the damage that occurs in normal adult somatic cells during successive mitotic cycles. Immortal cells have short but stable chromosomes and increased telomerase activity. Transitional cell carcinoma (TCC) has only a few useful markers of diagnostic or prognostic importance. The objectives of this study were to determine whether there was a correlation between telomerase activities and the grade or stage of TCC and whether the activity of the enzyme could serve as a biochemical marker of this tumor. MATERIAL AND METHODS: Telomerase activity was determined by examining, using a polymerase chain reaction-based assay designed using the telomeric repeat amplification protocol (TRAP), urine cell pellets obtained from 42 bladder cancer patients, 18 patients with primary hematuria, 19 patients with benign urologic disease, 14 patients with urologic malignancies other than TCC and 20 healthy volunteers. RESULTS: Telomerase activity was found in 24/31 patients with bladder tumors (77.4% sensitivity) and in 5/77 patients without tumors (93.5% specificity). No correlation was found between telomerase activity and the grade or stage of the tumor. Although none of the urine cell pellets obtained from the 20 healthy volunteers demonstrated telomerase activity, positive telomerase activity was found in two subjects in the benign urologic disease group and in three subjects in the other urologic malignancy group. It was demonstrated that gross hematuria was the cause of false-negative results in six of the nine patients (66.7%). but washing the pellets four times and diluting them before the TRAP assay solved this problem. CONCLUSION: These results indicate that telomerase activity may be a promising marker for TCC but the technical aspects of the technique must be improved before it is used in routine clinical practice as a standard method. False-negative results obtained using gross hematuric urine should be carefully reevaluated and cell pellets should be washed again and diluted before analysis.
Adolescent↗
The role of the pathologist in the evaluation of radical prostatectomy specimens.
OBJECTIVE: To compare the difference between the routinely reported pathology records and the results of re-evaluation of the same radical retropubic prostatectomy (RRP) specimens. MATERIAL AND METHODS: The RRP specimens of 114 patients initially reported by a general pathologist for routine purposes were re-examined and re-evaluated blindly with respect to the following parameters: organ confinement; capsular invasion; seminal vesicle invasion; lymph node metastasis; surgical margin positivity; Gleason grade and pathologic stage. Repeat and step sections were performed where necessary. Prostate mapping was done for each patient. RESULTS: A statistically significant discordance between the routine evaluation and the re-evaluation was observed with regard to capsular invasion, organ confinement, Gleason grade and pathologic stage. In addition to pathologic stage, Gleason grade and surgical margin positivity became significant prognostic factors after the re-evaluation. CONCLUSIONS: RRP specimens should be evaluated by an expert prostate pathologist by submitting whole prostate specimens and should include detailed prostate mapping.
Adult↗
The predictive value of purified protein derivative results on complications and prognosis in patients with bladder cancer treated with bacillus Calmette-Guerin.
PURPOSE: We investigate the correlation of purified protein derivative (PPD) results before intravesical bacillus Calmette-Guerin (BCG) instillations with prognosis and complications of BCG. MATERIALS AND METHODS: A total of 57 men and 4 women with proven intermediate or high risk superficial bladder cancer received 6 courses of intravesical BCG instillations following complete resection of tumors. Skin reactivity to a PPD derivative of Mycobacterium tuberculosis was tested before starting and 1 week after BCG. The test was considered positive if the induration was 10 mm. or more in diameter after 48 or 72 hours. The patients were grouped according to PPD responses and symptoms. The statistical analyses were performed between PPD positive and negative groups, and also between symptomatic and asymptomatic patients. The groups were compared for relapse rates, time to first recurrence, complication rates and clinical outcome. RESULTS: Most of the patients with systemic side effects were in the PPD positive group but only fever had a statistically significant difference and was more frequent in the positive group (p <0.05). The recurrence-free intervals after intravesical BCG therapy did not differ significantly between PPD positive and negative groups. However, the trend of longer recurrence-free survival was evident for symptomatic patients (p = 0.056). The numbers of tumor recurrences were 10 (52%) in the PPD negative group and 19 (51%) in the PPD positive group, which was statistically insignificant. CONCLUSIONS: Patients with systemic reactions to BCG had the longest disease-free survival. It seems that patients with an augmented reaction to BCG probably have better antitumor activity. Furthermore, although larger groups of patients are mandatory for statistical analysis, this study shows that hypersensitivity reaction against tuberculin could alert physicians of severe complications.
Adjuvants, Immunologic↗
Gynecomastia following chemotherapy for testicular cancer.
A 22-year-old man received 4 cycles of bleomycin, etoposide and cisplatin combination chemotherapy for clinical stage IIA embryonal cell carcinoma of the right testis. The treatment resulted in complete remission. Five months following cessation of the chemotherapy first on the left and then 2 weeks later on the right side painful gynecomastia developed. His hormonal values are all normal with no evidence of recurrence of the cancer. Gynecomastia on both sides resolved in 8 months spontaneously without any treatment. He is still in clinical remission 14 months after completion of the chemotherapy. We should be aware that gynecomastia following cytotoxic chemotherapy in a young man does not necessarily mean the return of the cancer.
Adult↗
[Staging of urinary bladder tumors with CT and MRI].
PURPOSE: The purpose of this study was to evaluate the performance of spiral CT and MRI in patients with bladder tumor. MATERIALS AND METHODS: In this study, patients with suspected urinary bladder tumor were evaluated by abdominal CT and MRI. This study included 32 patients. In 23 cases, transurethral resection (TUR), and in 9 cases radical cystectomy was performed. Additionally, pelvic lymph node dissection was performed in 9 patients. RESULTS: According to the pathological results of TUR-performed patients; the accuracy of spiral CT and MRI in preoperative staging of bladder tumors was 41.6% and 83.3%, respectively. The accuracy of spiral CT and MRI in preoperative staging of bladder tumors were 66.6% and 77.7% in patients who underwent radical cystectomy. Pelvic lymph node involvement was evaluated properly with MRI and CT. CONCLUSION: In the preoperative staging of bladder tumors, MRI is superior to CT. The superiority is more definite especially in early stage tumors.
Adult↗
Surgical management of renal cell carcinoma with inferior vena cava tumor thrombus.
BACKGROUND: The successful excision of a renal cell carcinoma (RCC) invading the inferior vena cava (IVC) remains a technical intraoperative challenge and requires a careful preoperative surgical management planning. Although a radical operation remains the mainstay of the therapy for RCC, the optimal management of the patients with RCC causing IVC tumor thrombus remains unresolved. In this study, we reviewed our experience in this group of patients and herein report the results. METHODS: Between July 1990 and August 1998, 11 patients with RCC with IVC tumor thrombus underwent surgical treatment. The mean patient age was 54.2 years and the male to female ratio was 1.75. The cephalad extension of the tumor was suprarenal in all cases, being infrahepatic in 6 patients, intrahepatic in 2, and suprahepatic with right atrial extension in 3 patients. All tumors were resected via inferior vena cava isolation and, when necessary, extended hepatic mobilization and Pringle maneuver, with primary or patch closure of vena cavotomy. Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) were used in 3 patients. RESULTS: The mortality rate was 9.1% (1 patient was lost on the 11th postoperative day). Complications occurred in 3 patients. The remaining 10 patients (90.9%) could be successfully discharged from hospital. Two of them were lost during follow-up because of tumor progression at the 43rd and 54th postoperative months. The 10-year Kaplan-Meier survival estimate was 71.4%, with a mean follow-up of 4.6 years. The presence of lymph node metastases and perinephric spread seemed to possess an adverse effect on the survival. Although the groups included small numbers of patients, there was no significant difference in survival in regard to the different levels of tumor thrombus extension into the vena cava. CONCLUSIONS: Surgical treatment is the preferred approach to patients with RCC and IVC tumor thrombi as it provides markedly better results when compared with the other therapeutical modalities. We believe that complete surgical excision of the tumor and the resulting thrombus with appropriate preoperative staging and a well-planned surgical approach, using CPB and DHCA when necessary, provide an acceptable long-term survival with a good quality of life expectation.
Adult↗
False-positive results of the NMP22 test due to hematuria.
PURPOSE: The problem with available markers for bladder cancer is their low specificity and low positive predictive value due to false-positive results. False-positive results of the NMP22 nuclear matrix protein test (Matritech, Cambridge, Massachusetts) are usually observed in some clinical categories that are usually associated with hematuria and pyuria. This problem is especially serious in bladder cancer since 85% of patients present with hematuria. We investigated the effect of the degree of hematuria and pyuria on NMP22 results in an experimental model and human subjects. MATERIALS AND METHODS: This study was performed in 202 urine samples from 30 healthy individuals (group 1), 20 with symptomatic urinary tract infection (group 2) and 32 with known bladder carcinoma (group 3). In the first group to achieve 0, 10, 100, 1,000 and 5,000 red blood cells per high power field the blood obtained from each patient was added to test tubes at 0.02, 0.2, 2 and 10 microl, respectively. RESULTS: In the first group median urinary NMP22 in healthy individuals was 4 units per ml. (range 1.6 to 9.5). When blood was added to the urine sample, the NMP22 increase paralleled the increase in the amount of red blood cells in the sediment. When greater than 2 microl./ml. blood or 1,039.5 red blood cells per high power field (range 278 to 1,438) were added to the urine of a healthy individual, the NMP22 level reached and surpassed the level in patients with bladder carcinoma. The leukocyte count in the urine sediment also had a significant impact on urinary NMP22 in group 2. The degree of hematuria and pyuria did not significantly effect NMP22 in group 3. The sensitivity, specificity, positive and negative predictive values of NMP22 were 78.1%, 66%, 59.5% and 82.5%, respectively. Test sensitivity increased as grade and stage progressed. CONCLUSIONS: In an experimental model pyuria and hematuria significantly affected urinary NMP22. The effect of white blood cells was more pronounced than that of red blood cells. The source of NMP22 in isolated hematuria remains to be elucidated. On the other hand, in group 3 the tumor was the main source of NMP22, and urinary erythrocytes and/or leukocytes had a negligible effect.
Biomarkers, Tumor↗
The free-to-total serum prostatic specific antigen ratio as a predictor of the pathological features of prostate cancer.
OBJECTIVES: Curative therapy and extended period of disease free survival for patients with prostate cancer is possible only if the radical prostatectomy is performed when the disease is organ confined. It has been shown that combined use of local clinical stage, Gleason score of transrectal needle biopsy and serum PSA can accurately predict the final pathological stage in men undergoing radical prostatectomy. Recently the free/total PSA (F/T PSA) has been shown to improve the specificity of serum PSA level in early detection prostate cancer. In this study the utility of F/T PSA ratio in prediction the final pathological features of the prostate cancer was investigated. METHODS: 52 patients who had undergone radical prostatectomy were included in this study with mean age of 63 (ranging from 49 to 73). According to the pathologic features of the tumors, patients were classified as organ confined in 37 (%71), specimen-confined in 39 (%75) and as with favorable pathology which was defined as organ confined or specimen confined with Gleason score lower than 7, 39 (%75) patients. RESULTS: Neither total PSA levels nor F/T PSA values correlate significantly with the pathological characteristics of the tumor. The logistic regression analysis showed that the biopsy Gleason score was the only variable that was able to predict the pathology of the tumor (p < 0,05). CONCLUSION: As a conclusion Gleason score of the needle biopsy specimen is the most predictive factor of the final pathological outcome. F/T PSA ratio did not provide additional information about predicting pathological stage.
Biopsy, Needle↗
Bladder cancer.
Bladder cancer is a common and chemotherapy-responsive tumor, related to tobacco smoking, environmental arsenic exposure, industrial dye exposure, and parasitic schistosomiasis exposure. Both reduction of carcinogen exposure and chemoprevention, possibly with cyclooxygenase 2 inhibitors, should reduce the incidence. The search for the ideal screening and monitoring test continues with some promising new candidates, including survivin. Although 10-year survival can be achieved in 87% of early-stage patients with muscle-invasive disease rendered T(0) and 57% of those rendered T(1) at second look after transurethral resection bladder tumor, most still require radical cystectomy. Continued improvements in surgical techniques permit gains in quality of life after the procedure. Ten-year survival can still be achieved with cystectomy in the face of grossly positive lymph nodes in 32% of T(2) and 10% of T(3) patients. A recent meta-analysis indicates that preoperative irradiation is unlikely to be beneficial, but definitive chemoradiation can produce significant 5-year survival rates in nonoperative candidates and those desiring bladder preservation. The Intergroup now has preliminary data from a Southwest Oncology Group-based trial showing a significant benefit for neoadjuvant methotrexate, vinblastine, doxorubicin, and cisplatin. The regimen of gemcitabine and cisplatin is equally efficacious with less toxicity than methotrexate, vinblastine, doxorubicin, and cisplatin. It has been adopted as the standard arm in a phase III trial for advanced bladder cancer, comparing it with the triplet of gemcitabine, paclitaxel, and cisplatin. Other active agents in bladder cancer include ifosfamide, carboplatin, docetaxel, and vinorelbine, and various doublets of these agents are being tested in phase II trials, with promising results.
Antineoplastic Agents↗
Microstaging of pT1 transitional cell carcinoma of the bladder. Does it really differentiate two populations with different prognoses? (pT1 subcategory).
INTRODUCTION: Our objective was to evaluate the feasibility and value of microstaging in pT1 transitional cell carcinoma (TCC) of the bladder in a well-defined group of patients treated with transurethral resection (TUR) only. MATERIALS AND METHODS: The clinical records of 152 patients who underwent TUR for the treatment of primary superficial TCC of the bladder between 1983 and 1997 were reviewed. Patients with primary carcinoma in situ and who received adjuvant intravesical treatments were excluded from study. We subclassified the pT1 tumors into two groups according to muscularis mucosae (MM) invasion (pT1 and pT1b). The recurrence and progression rate of cancers was analyzed according to the stage, grade, multiplicity and tumor size. Mean follow-up was 68 months. Estimation of the cumulative distribution of the disease-free interval in separate groups was calculated according to the Kaplan-Meier method. Multivariate analysis of the data was performed by using Cox regression method. A value of p < 0.05 was taken to be statistically significant with odds ratios. RESULTS: Of the 152 patients, tumor stage was pTa in 62 (40.8%) patients and pT1 in 90 (59.2%) patients. Among those pT1 tumors, MM was identified in 50 (55.5%) of cases (pT1a = 34, pT1b = 16). In the remaining 40 (44.5%) patients, MM could not be assessed. Kaplan-Meier analysis revealed that recurrence and progression were statistically significant for stage, multiplicity and grade of tumor. However, multivariate analysis revealed that stage was the only prognostic factor for recurrence and progression (p = 0.0001). CONCLUSION: The present study underscores the fact that pT1b tumors have a distinct natural history. If initial conservative treatment is selected, the patients must be followed very cautiously.
Adult↗
Determination of prognosis in patients with prostate cancer treated with radical prostatectomy: prognostic value of CD44v6 score.
PURPOSE: A third of the patients treated with radical prostatectomy experience progression even when tumors are confined pathologically to the prostate. CD44 may be a promising prognostic marker for determining malignant potential. However, there has not been a standard scoring system because of its heterogeneous staining pattern. Thus, we developed an objective scoring system to evaluate reliably CD44v6 (Bender Medsystems, Vienna, Austria) as a prognostic marker for prostate cancer. MATERIALS AND METHODS: A total of 22 patients with metastatic stage pT3bN0M0 or any pTN1M0 disease and 18 with nonmetastatic disease less than stage pT3bN0M0 were selected from a well examined group of 114 who underwent radical retropubic prostatectomy. Mean followup was 33 months (range 4 to 78). A combined CD44v6 score was determined by adding the scores of the primary and secondary areas. CD44v6 expression in terms of the CD44v6 score in primary and metastatic tissues was examined. The relationships of CD44v6 expression with pathological stage, progression and PSA-free survival were also evaluated. The prognostic value of the CD44v6 score for progression was analyzed by multivariate analysis. RESULTS: Progression in the metastatic group was significantly higher than in the nonmetastatic group (p <0.0001). CD44v6 expression of the primary tumors differed significantly in the 2 groups (p = 0.014). The CD44v6 score in primary tumor tissues inversely correlated with pathological stage (p = 0.004) and progression (p = 0.035), and positively correlated with PSA-free survival (p = 0.041). Furthermore, patients in the nonmetastatic group with a CD44v6 score of greater than 75 (cutoff value) had a significantly better prognosis (log rank test p = 0.0022), while those with a CD44v6 score of less than 75 had a prognosis similar to those in the metastatic group. On multivariate analysis pathological stage and surgical margin positivity were independent factors for progression but the CD44v6 score was not. CONCLUSIONS: According to our results the suggested CD44v6 score system is useful. A CD44v6 score of less than 75 may be a predictor of poor prognosis in the nonmetastatic group and this property may have potential application for planning adjuvant therapy.
Aged↗
Local staging of prostate cancer with endorectal surface coil MR imaging in a mid-field magnetic system.
To investigate the accuracy of endorectal surface coil magnetic resonance imaging (ecMRI) in a 1.0-T magnetic field for the local staging of prostate cancer, 25 patients were studied. In 14 Stages T1 and T2 tumors, 11 were correctly identified and 3 were overstaged. In 11 Stage T3 neoplasms, ecMRI was accurate in 7 cases, and the other 4 were understaged. The overall accuracy of ecMRI in 1.0 T was 72% and that was comparable to the reported accuracy of this technique in high-field systems.
Adenocarcinoma↗
Bilateral scrotal extraperitoneal herniation of ureters: computed tomography urographic findings and review of the literature.
Scrotal herniation of the ureter is an extremely rare and often misdiagnosed condition with possible serious surgical complications. Most reported cases occur in obese men during the fifth and sixth decades of life. Two types of ureteroinguinal hernias are defined: paraperitoneal (more frequent and acquired form with a peritoneal hernia sac in which other abdominal structures are found) and extraperitoneal (uncommon and congenital form without a peritoneal sac that is almost always composed of the ureter and fat tissue). A case of scrotal extraperitoneal ureteral hernia with exquisite computed tomography urographic and ultrasound findings is presented.
Aged↗