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INTRODUCTION AND OBJECTIVE:Renal cell carcinoma remains an aggressive malignancy with known substantial cross talk between cells. Exosomes (exo) are small extracellular vesicles (EVs) secreted from...

INTRODUCTION AND OBJECTIVES: As with any oncologic surgery, the surrogate for determining a complete tumor resection during a partial nephrectomy (PN) is a negative surgical margin (NSM). Although a PN prevents the loss of function in the renal functional mass, it carries the risk of incomplete tumor excision. With the introduction of the robotic surgical approach, which provided three-dimensional, highdefinition magnified vision, robotic partial nephrectomy (RPN) is increasingly being performed PN for the management of small renal masses.10,11 With the advantage of articulated robotic instruments and wider vision, it is possible to excise closer to the tumor and preserve more renal parenchymal tissue during RPN compared with an open partial nephrectomy (OPN). Thus, we compared the pathologic outcomes, including width of peritumoral surgical margin and margin positivity, after OPN and RPN in T1a RCC using propensity score matching analysis. METHODS: This was a propensity score-matched study including 702 patients with cT1a RCC treated with PN between May 2003 and July 2015. Perioperative parameters, including surgical margin width after PN, were compared between two surgical methods. After determining propensity score for tumor size and location, the width of peritumoral surgical margin was investigated. Multivariate logistic analysis to predict peritumoral surgical margin less than 1mm was analyzed. RESULTS: The mean width of peritumoral surgical margin was 2.61 2.15 mm in OPN group (n1⁄4385), significantly wider than the 2.29 2.00 mm of RPN group (n1⁄4317) (p1⁄40.042). The multivariate analysis showed surgical methods was significant factors to narrow surgical margin less than 1mm (p1⁄40.031). After propensity score matching, the surgical margin width was significantly longer in OPN (2.67 2.14 mm) group than RPN (2.25 2.03 mm) group (p1⁄40.016). A positive resection margin occurred in 7 (1.8%) patients in the OPN group and 4 (1.3%) in the RPN group. During the median follow-up of 48.3 months, two patients who underwent OPN had tumor bed recurrence. CONCLUSIONS: RPN may result in a narrower peritumoral surgical margin than OPN. Further investigation on the potential impact of such a phenomenon should be performed in a larger-scale study.

p1⁄40.52) and IPSS (19 v 20 p1⁄40.38) was equivalent. Vaporization was associated with significant increase in operative time 81 15 minutes range 40e110 p

The multitarget fluorescence in situ hybridization (FISH) probe set UroVysion (Vysis, Downers Grove, Illinois), containing probes to chromosomes 3, 7 and 17, and to the 9p21 band, has been recently shown to have high sensitivity and specificity for detecting transitional cell carcinoma. In this study we retrospectively tested 120 urine samples from patients with atypical, suspicious and negative cytology for whom concurrent and followup bladder biopsy data were available. We evaluated the ability of FISH to identify malignant cells in cytologically equivocal or negative cases.Archived slides from 120 voided (47) or instrumented (73) urine cytology specimens from patients with concurrent bladder biopsy and a minimum of 12 months of biopsy followup were subjected to hybridization with UroVysion. The cohort included patients with biopsy proven transitional cell carcinoma, which was grades 1 to 3 in 23, 35 and 24, respectively, and stages pTis in 3, pTa in 64, pT1 in 6, pT2 in 6 and pT4 in 3, while it showed negative histology in 38. Cytology findings were suspicious, atypical and negative for transitional cell carcinoma in 31, 49 and 40 cases, respectively. A positive FISH result was defined as 5 transitional cells or greater with a gain of 2 or more of chromosomes 3, 7 or 17, 12 cells or greater with 9p21 deletion, or 10% or greater of cells with isolated trisomy of 1 of chromosomes 3, 7 and 17.All except 12 of the 82 biopsy proven transitional cell carcinoma cases (11 pTa and 1 pT1 tumors) were positive by FISH (85% sensitivity). Sensitivity in patients with suspicious, atypical and negative cytology was 100%, 89% and 60%, respectively. Nine patients with atypical cytology had positive FISH in the setting of a negative concurrent bladder biopsy. However, 8 of these 9 patients (89%) had biopsy proven transitional cell carcinoma within 12 months following the date when the sample tested by FISH was obtained. The last of these patients with false-positive results had previously documented pTis disease, which was also present in the next bladder biopsy 15 months following the positive FISH result. The remaining 29 specimens from patients with negative biopsy and a negative 12-month followup tested negative by FISH (97% overall specificity).The UroVysion FISH assay provides high sensitivity and specificity to detect transitional cell carcinoma in cytologically equivocal and negative urine samples. These results emphasize the important role of this assay in the management of bladder cancer.

A 46-year-old male presented with a history of progressive unilateral penile girth expansion. The area was soft and painless, and the degree of enlargement was unrelated to penile erections. Surgical history was significant for a dermal graft procedure performed elsewhere 2 years previously for erectile curvature due to Peyronie’s disease. The operative note described use of a dermal graft without detailing its harvest and preparation. Physical examination demonstrated a 5 6 cm. lateral penile mass that was soft and nontender (fig. 1, A). Magnetic resonance imaging (MRI) revealed a well-defined mass with high intensity signal on T2-weighted imaging and no contrast enhancement (fig. 2). On penile exploration a keratin filled mass with intermingled hair was found (fig. 1, B). Subsequently the keratin was removed and an epidermal layer was identified at the base of the lesion. The epidermis was sharply removed from the underlying dermis. Artificial erection confirmed that the graft was still intact, and the degloved penile skin was then approximated to the mucosal skirt. Two months later the patient had an excellent cosmetic result and denied any change in erectile function.

INTRODUCTION AND OBJECTIVE: Patients with positive margins at radical prostatectomy represent a heterogeneous group with a wide range of post-prostatectomy outcomes. In attempt to better stratify those at high risk for biochemical failure, we evaluated the power of estimated tumor volume, margin amplitude, and margin location in the prediction of biochemical failure. METHODS: We reviewed our database of 2410 patients who underwent radical prostatectomy and isolated 453 total patients (18.8%) with positive surgical margins, with an overall pT2 positive margin rate of 3.9% and a pT3 margin rate of 15.2%. Kaplan-Meier, log-rank, and multivariate logistic regression analyses were undertaken to assess the relationship between estimated tumor volume, margin amplitude, and margin location and biochemical-free survival. RESULTS: Increasing estimated tumor volume, when stratified by quartile (

salvage treatment was associated with disease severity, shorter time to BCR, and year of BCR. Moreover, patient-specific factors (i.e. race, body-mass index and age) were not significant predictors of secondary treatment. Though we found that patients are being treated more aggressively in contemporary years, even after adjustments for disease severity, the impact of this approach on long-term survival remains to be determined.