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ABSTRACT: With no more than 60 reported cases, tumors of the seminal vesicles are rare. Because of poor and nonspecific symptoms diagnosis is often very difficult. This report presents a case of a 56-year-old man with right renal agenesis and intermittent hematospermia and bilateral cystic masses of the seminal vesicles. Transrectal biopsies of the cystic lesion revealed a papillary clear cell adenocarcinoma. The patient underwent radical prostatectomy and pelvic lymphoadenectomy. Lymph node metastases were found on histological examination. The patient received 4 cycles of chemotherapy and pelvic radiotherapy. He remains disease free 21 months after surgery. Radiological imaging in patients with hematospermia and hematuria will allow disease detection at earlier stages. Immunohistochemistry and histomorphology can be used for differential diagnosis. Surgery with clear margins offers the best chance to cure. Hormonal and radio-chemotherapy have a role as adjuvant and palliative treatment.
International Journal of Surgical Pathology 06/2012; · 1.00 Impact Factor
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ABSTRACT: Introduction. As it is well known, High Intensity Focused Ultrasound (HIFU) is a minimally invasive procedure for prostate cancer. Many investigators reported their series of patients, demonstrating the effectiveness of the treatment. The most majority of Authors, however, do not report the side effects and the complications of the procedure, which is the aim of our study. The diagnosis and management of complications is discussed, and the oncologic outcome is reported in terms of quality of life. Materials and Methods. We report our experience in 89 patients, low-, intermediate-, and high-risk patients according with D'Amico classification. All data collected along the study were analyzed, including side effects and complications of the procedure. Results. Our series demonstrates the effectiveness of the procedure, in line with larger series reported in literature by other investigators. The most important side effects are sexual function impairment and transient incontinence in a minority of cases. Minor complications are reported as well as rare cases of major complications, which can require surgical treatment.
Advances in Urology 01/2012; 2012:960835.
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11/2011; , ISBN: 978-953-307-319-4
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ABSTRACT: Laparoscopic adrenalectomy is considered the treatment of choice in the surgical management of the most majority of the adrenal diseases. Nevertheless, one of the much discussed topics is the dimensional cut-off for the laparoscopic treatment and it is not clear if laparoscopy should be used in large adrenal masses.Introduction. Laparoscopic adrenalectomy is the goal standard in benign adrenal masses smaller than 6 cm, while its advantages in masses larger than this cut-off and in malignant lesions is still discussed.
We present six cases of laparoscopic adrenalectomy since November 2008 for masses between 7 and 15 cm; 4 men and 2 women. 3 right and 3 left. A complete adrenal endocrinological evaluation demonstrated that the lesions were not secreting tumors. All patients were studied with CT scan.The technique was performed using a flank approach with a 45° tilt. We used 5 trocars in patients who had the masses on the right side, and 4 in those who had the lesions on the left side. After creating an adequate pneumoperitoneum through an open access, the posterior peritoneum cutting, mobilization of the colon, medial dissection of the adrenal gland, and ligation of the main adrenal vein were performed. The adrenal gland was carefully dissected by Ultracision. The mass was extracted by endobag through an additional subcostal port. The mean operative time was 120 minutes. Blood loss was about 50 cc. The drainage was removed on day 2 after surgery and the patient was discharged on day 3. No postoperative complication occurred. The anatomopathologic exam gave evidence of myelolipoma and hemorrhagic cyst.
The benefits of the laparoscopic approach are widely demonstrated and consist of a shorter hospital stay, reduced morbility, decreased analgesic requirement, and reduced intraoperative blood loss. One of the most discussed topics is the dimensional cut-off and it is not clear if the laparoscopy approach should be used in large adrenal masses (considering the longer operative time and increasing blood loss). Many surgeons performed laparoscopic adrenalectomy for masses of up to 13 cm, thus demonstrating that this procedure is safe and effective. A limitation of laparoscopic approach for adrenal giant masses is the increased risk to treat an adrenal cortical carcinoma.
Our experience, supported by the literature, demonstrates that the laparoscopic adrenalectomy is a feasible and effective surgical technique also in the case of giant masses. Preoperative diagnosis has a predominant role to determine the contraindication of this technique (invasive adrenal carcinoma).
Urologia 11/2011; 78 Suppl 18:S54-8.
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ABSTRACT: Testicular cancer is the most common malignancy in 20- to 34-years-old males. It has been stated that testicular cancer derives from a precocious lesion, the carcinoma in situ of the testis, also known as Intratubular Germ Cell Neoplasia (IGCN) or Testicular Intraepithelial Neoplasia (TIN). This lesion deserves great attention, because the diagnosis of CIS may lead to a precocious diagnosis of testicular cancer. Generally, the diagnosis of CIS is incidental. Every physician should know the management of this precocious lesion, as the correct management of CIS can lead to a decrease of the incidence of overt testicular cancer (the most frequent malignancy in young men). Moreover, the correct diagnosis and management of CIS can shorten the hospital stay, reduce the cost, and improve the social impact of the testicular cancer.
Acta bio-medica: Atenei Parmensis 08/2011; 82(2):162-9.
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ABSTRACT: As it is well known, the gold-standard to treat ureteric and pelvi-caliceal transitional cell carcinoma (TCC) is nephroureterectomy. Nevertheless, in particular circumstances, such as solitary kidney, a more conservative treatment is needed. Conservative treatment has been reported for low-grade TCC, also. In this paper we discuss the laparoscopic approach to low-grade ureteric TCC in patients with otherwise normal urinary tract. After reporting a case of a patient treated with this approach, we deal with some technical aspect of the surgical procedure and with the pre-operative and post-operative management of the patient.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 06/2011; 83(2):99-101.
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ABSTRACT: The first laparoscopic adrenalectomy was performed and described by Gagner in 1992. Since then, this technique has become more and more widespread and there is common agreement in the literature that it is the gold standard for adrenalectomy. Laparoscopic adrenalectomy is indicated in benign adrenal masses, and it is routinely performed in masses smaller than 5 to 7 cm. The laparoscopic procedure in masses larger than this cut-off is discussed, although many investigators agree about its feasibility, safety and effectiveness. We present this case: man, 39 years old, large palpable mass in the right hypochondrium. Computed tomography scan (CT) suggested the diagnosis of giant adrenal myelolipoma (15x12x7 cm). Complete adrenal endoclinologic evaluation showed that the lesion was not a secreting tumor. Laparoscopic adrenalectomy was performed with good results.
Surgical laparoscopy, endoscopy & percutaneous techniques 08/2010; 20(4):288-90. · 1.23 Impact Factor
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ABSTRACT: Vanilloids are natural molecules identified in a plethora of foods normally ingested through the diet. They mediate apoptosis through a direct pathway (independent of TRPV-1, the receptor for vanilloids) and through an indirect pathway, i.e., thanks to the interaction with TRPV-1 and the successive intracellular calcium growth [Ca2+]i. Some vanilloids, such as capsaicin, dihydrocapsaicin and resiniferatoxin (the ultrapotent analogue of capsaicin, extractable from Euphorbia resinifera), may be considered as coenzyme Qantagonists: in fact, they inhibit the run of the electrons through the electron transport chain, so determining an excess of reactive oxygen species (ROS). A second effect of the interaction between the vanilloids and TRPV-1 receptor may be reported: it is the fast decrease of the transmembrane mitochondrial potential (delta psi m). Through the direct pathway, on the contrary, the vanilloids induce apoptosis also interacting with caspases, particularly caspase 1 and 3. On the whole, the vanilloids are able to lead to the intracellular calcium growth and consequently to the evidence of precocious and late elements of apoptosis.
Acta bio-medica: Atenei Parmensis 05/2009; 80(1):13-20.
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ABSTRACT: High-Intensity Focused Ultrasound (HIFU) represents an alternative choice in mini-invasive treatment of prostate cancer. The technology of the device used to perform the treatment allows to exactly destroy a pre-selected area and to save all the tissues around it. We report our experience on the effectiveness and complications of this tecnique.
From May 2006 to April 2007, 25 patients with prostate cancer were treated through Ablatherm (EDAP France) in spinal anesthesia. In the first six patients HIFU and TUR-P (Trans-Urethral Resection of Prostate) were performed in the same session and a suprapubic catheter was placed. In the other 14 patients HIFU was afterwards performed. In these patients a trans-urethral catheter was placed. All patients were divided into three groups: low risk (17 patients), intermediate risk (6 patients) and high risk (2 patients). The follow-up consisted in PSA evaluation after 1, 3, 6, 9, 12 months and in transrectal biopsy after six months. Complications related to the treatment, and symptomatological and sexual life tests were evaluated before and after the treatment.
HIFU overall success rate was 84% (biochemical relapses in only 4 patients out of 25). Success rate was represented as follows: 94.2% in the low risk group, 83.4% in the intermediate risk group and 0% in the high risk group. No complications occurred during the treatment nor in the immediately post-operative time.
We demonstrated that HIFU represents a useful alternative choice in mini-invasive therapy of prostate cancer. Particularly, results are remarkable in localized (low-intermediate risk) and low morbility prostate cancer. The role of this procedure in high risk patients needs to be further evaluated. Transrectal HIFU represents a mini-invasive therapeutic option that makes the treatment of prostate cancer possible in 84% of cases. Our results agree with the literature data and demonstrate that the success of the procedure depends on the correct indication of treatment and is strictly related to progression risk parameters.
Acta bio-medica: Atenei Parmensis 01/2009; 79(3):211-6.
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ABSTRACT: Radical prostatectomy is followed by postoperative pain, that can be linked to potential morbidity. Aim of this study is to compare efficacy of epidural infusion of ropivacaine and fentanyl versus intravenous administration of morphine in terms of reduction of pain and possible complications.
We have considered 73 consecutive patients who underwent a retropubic radical prostatectomy. For analgesia control we have considered the use of epidural infusion of ropivacaine and fentanyl (Group R) in 48 patients, compared to continuous intravenous administration of morphine (Group M) in 25 patients. Evaluation criteria have been: blood pressure, heart and breath rate, sedation state, nausea and vomit, entity of pain with VRS scale (Verbal Rating Score) at rest and in movement in the first 72 hours, canalization and need of additional analgesia.
VRS values were lower in Group R especially during movement, and need of additional analgesia was reported in one patient of Group R, and in three patients of Group M; assumption of morphine was interrupted in three patients. Epidural catheter was removed for malfunction in three patients, and seven patients complained for leg paresthesia.
Sedation resulted higher in group M. Mobilization in second day occurred with fewer difficulties for patients of group R, while canalization resulted delayed in group M. Results underlined a good analgesic cover in both groups. Advantages of epidural analgesia are represented by the use of smaller doses of opioids, fewer cardiocirculatory and respiratory side effects, lower incidence of nausea and vomit, early canalization and post-operative mobilization.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 04/2007; 79(1):7-11.
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ABSTRACT: The most greater part of the tumors ureteralis are of malignant nature, they are verified especially in the elderly patient and they have a preference for the distal third of the ureter. Of the tumors benign ureteral, the emangioma is a very rare vascular neoplasm. The symptoms aspecificis of presentation are: hematuria, colic type pains, hydronephrosis and bladder inflammation. Thanks to the refinement of the radiological techniques (Urography, CTscan and eventually the ascending pyelography) and also to the simultaneous aid of the anatomopathologist, it is possible to obtain an accurate description of this pathology in a precocious stage in order to carry out a conservative approach. The peculiarity of the clinical case from us described depends on the fact that it deals with an occasional find, reaches our observation for appearance of severe hydronephrosis caused by ureteral stones, resolved him with methodic endoscopic.
Acta bio-medica: Atenei Parmensis 10/2005; 76(2):115-7.
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ABSTRACT: Uretero-vascular fistulae are rare. As compared to aortic, uretero-iliac fistulae are by far more frequent according to a 1:8 ratio. We present one case of uretero-prosthetic fistula in a man operated upon the resection of an aortobisiliac aneurysm and Dacron prosthetic graft; six years later, a blunt trauma to the body was followed by a threatening shock, resistant to medical measures. Two subsequent emergency operations allowed to a difficult diagnosis and a life-saving repair of the fistula. Some hypotheses on the pathogenesis of the condition are discussed as well as its clinical problems.
Archivio italiano di urologia, andrologia: organo ufficiale [di] Società italiana di ecografia urologica e nefrologica / Associazione ricerche in urologia 07/2005; 77(3):151-2.
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ABSTRACT: Carcinosarcoma of the bladder is a very unusual neoplasm that arises more frequently in males with a greater incidence in the seventh decade of life. There are no patognomonic clinical findings or symptoms to address its presence. Symptoms, as for other bladder cancers, are fundamentally represented by haematuria and dysuria. It has a very aggressive clinical behaviour and it is histologically characterized by a malignant epithelial component associated with a sarcoma-like (sarcomatoid) component variably represented.
Acta bio-medica: Atenei Parmensis 05/2004; 75(1):74-6.
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ABSTRACT: Collecting duct carcinoma of the kidney is a rare and aggressive neoplasm of the distal collecting tube, often metastatic at the time of the diagnosis, for which there is no established therapy. We herein describe the case of a 65-year-old man with a renal cancer with a particular immunohistochemical pattern and pathologic aspect. The lesion was diagnosed as a tumor borderline between a urothelial carcinoma with intraductal spreading and a collecting duct carcinoma with calyceal and pelvic spreading. The patient is disease-free 11 months after diagnosis, after radical surgery with adjuvant chemotherapy (carboplatin and gemcitabine) and radiotherapy of a local recurrence. Owing to the common embryologic origin of collecting duct and transitional urothelial cells, several authors have reported an association between collecting duct carcinoma and urothelial cancer. The literature is reviewed to evaluate drugs active against urothelial cancer (like ifosfamide, paclitaxel, carboplatin and gemcitabine). This field should be investigated in the future, in the framework of a neoadjuvant or adjuvant chemotherapy able to support radical surgery for local and advanced collecting duct carcinoma.
Tumori 92(6):545-8. · 0.86 Impact Factor
