Grand Journal of Urology
E-ISSN : 2757-7163

Urological Oncology
Original Article
Objective: In this study, histological, pathological and clinical characteristics that may affect multifocality rate and multifocality in renal tumors were investigated. Materials and Methods: A total of 162 patients who underwent radical nephrectomy with the diagnosis of renal tumor from our urology clinic and urology clinics in two other hospitals between May 2002 and April 2006 and whose results were available were included in the study. Kidney samples were evaluated regarding multifocality through sections made macroscopically at an interval of 3 mm. Results: Of the patients included in the study, 92 (56.8%) were male and 70 (43.2%) were female. The mean age of the patients was 59.98 years (22-87). In 11 (6.7%) of 162 patients, a multifocality focus was pathologically observed. Satellite lesions were radiologically identified in two (18.2%) of the patients with multifocality. On the other hand, satellite lesions could not be identified radiologically in nine patients (5.5%). Univariate and multivariate analyzes were performed to determine the relation between pathological, histological, and clinical characteristics and multifocality. There was no significant relation between age, gender, smoking, the location of the tumor, pathological stage, lymph node involvement, the presence of metastasis, the size of the tumor, and histology of the tumor. Univariate analysis results showed a statistically significant relation between renal capsule involvement and renal vein involvement and multifocality (p=0.015 and p=0.004, respectively); however, only renal capsule involvement was found to be associated with multifocality in multiple logistic regression analysis (p=0.008). Conclusion: In our multicentric study including 162 patients, the multifocality rate in renal tumors was 6.7% (11 patients). There was a significant relationship between capsule involvement and multifocality (p=0.015 – p=0.008). Meta analysis is required to determine the rate of multifocality in renal tumors and identify with which clinical, pathological, and histological characteristics it is associated.
Objective: Levels of insulin-like growth factor 1 (IGF-1) have been associated with prostate carcinoma. We have investigated whether IGF-1 level has an early predictive value for the biochemical relapse in the prostate carcinoma patients with a negative surgical margin who underwent curative surgery. Materials and Methods: We retrospectively analyzed 82 patients who were followed-up regularly and did not receive neoadjuvant or adjuvant chemotherapy. We classified patients as having Gleason scores ≥7 and
Grand J Urol 2021;1(2):66-70, DOI: 10.5222/GJU.2021.39974
Objective: To investigate the value of D-dimer, a marker of fibrinolysis, in metastatic and non-metastatic prostate cancer. Materials and Methods: A retrospective analysis was performed on 138 male patients including 52 patients with prostate cancer and 86 with benign prostatic hyperplasia. Participants who had factors that altered D-dimer levels were excluded. The mean ages of the groups were similar (70 ± 8 vs 68 ± 8, p= NS). In addition, data regarding biochemical findings, prostate-specific antigen and hemostatic markers, including D-dimer, were retrieved from the database of our hospital. The cut-off point of D-dimer was 0.5 mg/L. Data from scintigraphy and magnetic resonance imaging (MRI) scans related to metastasis were also considered. Patients who showed findings of metastasis according to scintigraphy and lumbosacral MRI were accepted as having metastases. Positive findings in only scintigraphy in any area were considered suspicious for metastasis. Results: Patients with prostate cancer had higher D-dimer levels than benign prostate hyperplasia patients (p= 0.024). Sixteen patients with metastatic prostate cancer and suspicious for metastasis had markedly high D-dimer levels compared to benign prostate hyperplasia and non-metastatic prostate cancer patients. Conclusion: prostate cancer, especially when metastatic, may increase D-dimer levels.
Grand J Urol 2021;1(3):101-108, DOI: 10.5222/GJU.2021.40085
Objective: To specify the prognostic factors predicting complication rates and postoperative renal function in patients operated with partial nephrectomy. Materials and Methods: Our health center"s archive system was scanned retrospectively for the time interval between January 2006- January 2021 for patients operated with partial nephrectomy for renal mass. History, comorbidities and laboratory results, operational information, tumor morphologies in radiographic images and its specified scores (R.E.N.A.L. score, PADUA score, C-index), peroperative and postoperative complications and pathology results of 148 regularly followed-up patients were analyzed. Results: Mean age of the patients was 55.04±10.91 years, ratio of male to female was 1.27 and mean tumor size was 3.56 cm. Mean follow-up period was 55.53±42.26 months. Postoperative creatinine value in the 6th month showed an increase of 0.18 mg/dl compared to preoperative value. Estimated glomerular filtration rate (eGFR) also decreased by an average of 18.3%. Operation of grade 4 tumors significantly affected the postoperative renal function. PADUA score (p=0.023) had a significant effect on postoperative GFRs and duration of ischemia. Also, difference in pre-and postoperative GFRs and its percentage change were significantly affected by C-index (p=0.035, p=0.042). Pathological size (p=0.038), R.E.N.A.L. score (p=0.001), PADUA score (p
Case Report
Non-germ cell testicular tumors are rarely seen. Sex-cord stromal tumors, which make up the majority of testicular tumors other than germ cell tumors, share common immunohistochemical and histomorphological features. Our aim in presenting this case is to define the Sertoli cell nodule (SCN), which is one of the relatively rare primary testicular pathologies that can be detected in half of adult undescended testes, with its histomorphological and immunohistochemical features, and to make its differential diagnosis.
Grand J Urol 2022;0(0):, DOI: 10.5505/GJU.2022.70299
Immunosuppressive therapy is related to the increasing frequency of malignancies after transplantation. A small percentage (4.6%) of malignancies seen in kidney transplant patients are renal cell carcinomas (RCC) which occur almost exclusively in native kidneys. The prognosis of RCC largely depends on the presence of metastasis. Metastatic disease is very rare in small renal masses. In this case report, we aimed to present our case of approximately 4 cm-mass of metastatic RCC in our kidney transplant patient. During the examination due to exhaustion and weight loss, multiple suspicious metastatic lesions were observed in non-contrast computed tomography. In the patient who had multiple bone metastases on the whole-body bone scintigraphy, prostate cancer metastasis was considered in the first plan due to a history of prostate cancer before transplantation. This diagnosis could not be supported with prostate-specific membrane antigen-positron emission tomography/computed tomography (PSMA-PET/CT) scan. Whole body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was performed. A hypermetabolic mass lesion in the left kidney, multiple hypermetabolic lesions in the liver, in the left aortorenal junction, and in the skeletal system were observed. A biopsy was performed from the metastatic mass in the right lobe of the liver and the result was reported as renal cell carcinoma metastasis. Immunohistochemistry evaluation demonstrated positive staining for PAX-8, CK19, CD10 and negative staining for CK7, CK20, GATA-3, NAPSIN A, TTF-1, PSAP, glutamine synthetase and arginase. With all these findings, it was thought that the primary of metastases was the 4-cm mass in the left native kidney.
Grand J Urol 2021;1(1):33-36, DOI: 10.5222/GJU.2021.98609
Retroperitoneal liposarcoma (RPLS) is a rare tumor. Early diagnosis and treatment are difficult due to absence of specific clinical presentations. We report a case of a 66-years-old woman who succesfully underwent complete surgical resection for a giant retroperitoneal liposarcoma. The complete surgical resection is the most important predictor of local recurrence and overall survival. We believe that complete surgical resection involving adjacent organs is a curative treatment to increase overall survival, especially in the presence of invasion of large tumors.
COVID-19 is a highly contagious disease. This condition affects the decision of both the patient and the surgeon about the surgery of newly diagnosed cancer patients and it may also result in delays in cancer surgeries because of the limitations in healthcare applications. In our particular case, it was aimed to present the transition of the cancer from the localized stage to distant spread stage cancer since the patient who was pre-diagnosed with RCC and who was recommended surgery, did not want to undergo surgery due to COVID-19 pandemic and its risks. Our case was a 49-year-old female patient. In her computed tomography, a 58x70 mm heterogeneously enhancing solid lesion which showed exophytic extension from the middle zone of the right kidney to the lower pole was observed. Surgery was recommended for the patient but the patient claimed that she did not want to undergo surgery due to the risk of COVID-19 pandemic. The patient made an application for the surgery 8 months later. The new magnetic resonance imaging of the patient showed that there was a mass lesion of approximately 76x76x80 mm in size, which involved middle-lower part of the right kidney and extended into the opening of the renal vein VCI by invading the renal vein. Radical nephrectomy and thrombectomy procedure was applied to the patient with RCC? tumor. Due to psychosocial problems caused by the pandemic, surgeries are delayed and an acceleration of the cancer progression from the localized stage to the distant spread stage occurs indispensably.
Grand J Urol 2021;1(3):142-145, DOI: 10.5222/GJU.2021.22931
Primary or secondary lymphoma of the prostate is a rare condition. Mantle cell lymphoma (MCL) represent 4-9% of all lymphomas. Prostate involvement with MCL is very rare, with only 11 reported cases up to now. Here we present a case with lower urinary tract symptoms and prostate-specific antigen (PSA) elevation diagnosed with MCL of the prostate. Prostate biopsy was performed in a 70-year-old patient due to increased PSA. After the pathology result was reported as prostatic MCL, imaging studies and sampling of additional pathological specimens were performed for staging. An improvement was observed in the urinary system complaints of the patient who started chemotherapy regimen. While prostatectomy was performed in some of the prostatic MCL cases reported previously, in some, no additional treatment was required after chemotherapy. Our case is the only prostatic MCL case with elevated PSA levels, but did not receive the diagnosis of prostate cancer. Physicians should keep in mind that, prostatic MCL can present with nonspecific symptoms. Staging should be performed in patients whose histopathologic diagnosis is lymphoma of the prostate so as to determine appropriate treatment options.
Review Article
Prostate cancer is one of the most common tumor in males. Radical prostatectomy, radiotherapy and watchful waiting are the main treatment options in localized disease. Radiotherapy together with hormonotherapy is accepted as the standard of care in patients with advanced stages. Surgery or radiotherapy has comparable local control and survival outcomes in localized disease. During recent years a significant reduction in the rate of serious side effects has been achieved due to the development of modern radiotherapy techniques. With the use of these techniques such as Intensity-modulated radiotherapy (IMRT), Image-guided radiotherapy (IGRT), Stereotactic body radiotherapy (SBRT), high doses can be given safely and the rates of serious short-or long-term side effects have not exceeded 1 percent. Modern radiotherapy techniques allow dose escalation for the target volume, and due to its achievement of sharp dose gradient around the target volume and enable to increase radiation doses homogeneously within the target volume without exceeding the tolerance doses in organs at risk. In the last few years hypofractionation has gained popularity in the curative radiotherapy of prostate cancer.
Focal ablation therapies in prostate cancer have been actively evaluated in the light of recent literature. According to published data,focal ablation therapies appear to be well tolerated and have an acceptable side effect profile. Moreover, while clinical outcomes were not homogenous, short-term oncological results of some focal ablation therapies such as laser and irreversible electroporation (IRE) have been found as good as curative ones. While waiting long-term oncological results, focal ablation therapies in prostate cancer are beinmg used increasingly.