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Objective: To outline our experimental gonadal tissue cryopreservation (GTC) protocol that does not disrupt the standard of care in medically-indicated gonadectomy for patients with differences of sex development, including highlighting the multidisciplinary collaborative protocol for when neoplasm is discovered in these cases., Methods: Two patients with complete gonadal dysgenesis who were undergoing medically-indicated prophylactic bilateral gonadectomy elected to pursue GTC. Both were found to have germ cell neoplasia in situ on initial pathologic analysis, requiring recall of the gonadal tissue, which had been cryopreserved., Results: Cryopreserved gonadal tissue was successfully thawed and transferred to pathology for complete analysis. No germ cells were identified in either patient nor were found to have malignancy, so further treatment beyond gonadectomy was not indicated. Pathologic information was communicated to each family, including that long-term GTC was no longer possible., Conclusion: Organizational planning and coordination between the clinical care teams, GTC laboratory, and pathology were key to handling these cases with neoplasia. Processes that anticipated the possibility of discovering neoplasia within tissue sent to pathology and the potential need to recall GTC tissue to complete staging included (1) documenting the orientation and anatomical position of tissue processed for GTC, (2) defining parameters in which tissue will be recalled, (3) efficiently thawing and transferring GTC tissue to pathology, and (4) coordinating release of pathology results with verbal communication from the clinician to provide context. GTC is desired by many families and at the time of gonadectomy and is (1) feasible for patients with DSD, and (2) did not inhibit patient care in 2 patients with GCNIS., Competing Interests: DECLARATION OF COMPETING INTEREST Authors have nothing to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Lynch Syndrome (LS) entails a defective DNA mismatch repair system, which is the postreplicative proofreading and editing system, ensuring our genome's integrity. LS predisposes to several cancers, most commonly colorectal and endometrial cancers. LS occurs in approximately 1 in 250-1000 people. LS is associated with urological malignancies with upper tract urothelial carcinoma the most common, although still clinically underestimated. Other urologic malignancies possibly associated with LS include bladder, prostate, testis, and renal cell carcinoma. Ascertaining their true prevalence in LS is mandatory for their and their relatives' diagnosis and treatment. Awareness regarding identifying patients at risk for LS through assessment of personal and familial oncologic history is critical among urologists., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Less than 100 cases of prostate carcinosarcoma have been described in published studies. Most of these cases describe symptoms due to bladder outlet obstruction that typically results in transurethral resection of the prostate. Our patient presented with tenesmus and stranguria due to prostate carcinosarcoma that developed years after being treated with external radiation and androgen deprivation for prostate adenocarcinoma. Because of the patient's escalating symptoms, a pelvic exenteration with creation of urinary and fecal diversions was performed. Despite the dismal survival associated with prostate carcinosarcoma, palliative surgical extirpation can be successful in patients with debilitating pain.

Objectives: To review the world literature for reports of cutaneous metastases from primary genitourinary malignancies and compare them with our experience during a 10-year period. Cutaneous metastases from primary visceral malignancies are uncommon manifestations of advanced disease. Among patients with urologic malignancies, the incidence and appearance of cutaneous metastases are not well established and recognition is poor among practicing urologists., Methods: A Medline search and manual bibliographic review was performed to identify peer-reviewed reports pertaining to cutaneous metastases from all visceral malignancies. A comparative review of all pertinent cases arising from primary urologic malignancies was performed. A comprehensive search of our institution's tumor registry was performed to identify all analytic cases of urologic malignancy diagnosed, treated, and followed up between 1990 and 2000. Clinical and pathologic data were collated., Results: We identified 2,369 reported cases of cutaneous metastases arising from 81,618 primary solid visceral malignancies, for an overall incidence of 2.9%. Dermatologic spread from primary urologic malignancies of the kidney, bladder, prostate, or testes was noted in 116 (1.3%) of 10,417. The incidence of cutaneous metastases from the kidney, bladder, prostate, and testes was 3.4%, 0.84%, 0.36%, and 0.4%, respectively. Overall, 436 cases of cutaneous metastases from urologic organs were identified in the English-language literature. We identified nine additional cases of pathologically confirmed cutaneous metastatic urologic tumors at our institution in the past 10 years. The most common presentation was an infiltrated plaque or nodules. Most cases displayed clinical features that mimicked common skin disorders. The median disease-specific survival was less than 6 months from the presentation of cutaneous metastasis., Conclusions: Cutaneous metastases from urologic tumors are uncommon and occur in 1% of patients with advanced disease. Urologic skin metastases are most common from renal tumors, followed by those of the bladder and then prostate. Their clinical appearance may mimic other common dermatologic disorders affecting patients with advanced malignancies. Definitive diagnosis requires an index of suspicion and skin biopsy. Cutaneous metastases from urologic malignancies are associated with a poor prognosis.

Objectives: To report our experience treating sarcomas in 20 consecutive patients., Methods: Pretreatment and follow-up data were obtained from 20 adult patients consecutively treated between 1992 and 1998 for primary or locally recurrent genitourinary sarcoma., Results: Eight patients (40%) were classified as having high-grade and 12 (60%) low-grade disease. Except for 3 patients, the primary treatment was surgery alone. The median follow-up was 52 months. The actuarial disease-specific 5-year survival rate was 84% in all patients and was 100% for patients with Memorial Sloan Kettering Cancer Center (MSKCC) Stages 1-2 and 54% in MSKCC Stages 3-4. The disease-specific survival was significantly better in low-grade tumors (log-rank test, P = 0.0063) and inguinal-scrotal tumors (P = 0.019), tumors 5 cm or less (P = 0.039), and MSKCC Stages 1-2 tumors (P = 0.0035)., Conclusions: The results of this study with a high proportion of low-grade, low-stage, and inguinal-scrotal sarcomas demonstrate the favorable prognosis of these subgroups.

A percutaneous fine-needle aspiration biopsy of metastatic tumor and/or retroperitoneal, pelvic, or abdominal lymph nodes was accomplished in 101 patients. A diagnosis of metastatic disease was confirmed by this method in 49 patients. In 26 patients, surgical excisional biopsy or exploratory laparotomy was avoided. An unknown pelvic mass causation was diagnosed in 3 patients. In 15 of 57 patients with localized bladder, prostate, or testis cancer, involvement of regional lymph nodes was confirmed by transabdominal find-needle aspiration. All 57 transabdominal aspirations were performed without complications. The method is inexpensive, safe, and can have a high accuracy in diagnosing a local tumor spread or distant metastases.

Recently, techniques have been developed that allow in vitro growth and chemosensitivity testing of human malignancies. We report our initial experience with the clonogenic, or colony-forming, assay as applied to genitourinary malignancies. Over the past two years, 172 specimens of genitourinary tumors were sent for assay. Thirty-three per cent were not plated, either because of insufficient quantity of cells obtained in the sample or because of the low viability percentage as determined by trypan blue exclusion. Forty-seven per cent showed adequate growth for chemosensitivity testing whereas 20 per cent of the samples showed inadequate growth. A major problem was obtaining adequate numbers of viable cells. Several other problems make it difficult to draw clinical correlations from in vitro findings. The method appears promising for several potential applications, but further studies will be needed before the final utility of the methods is defined.

The first report of a neurofibrosarcoma arising within the spermatic cord is presented. The light and electron microscopic features are discussed.

CT-guided needle aspiration biopsy has been used for staging of genitourinary tumors. The display of structures provided by CT is particularly suited for complex anatomic sites such as spine, pelvis, thorax, permitting selection of the shortest and safest route for the needle, away from the aorta, vena cava, and pleural surface. Another advantage of CT is its ability to detect soft tissue components of the tumors and the presence of central necrosis therefore targetting the biopsy toward the part of the lesion with the greatest diagnostic yield.

A case of metastatic carcinoma to the spermatic cord is presented. The previous 12 cases documented in the literature are reveiwed. In the majority of cases the primary tumor occurred in the gastrointestinal tract with metastasis to the spermatic cord by retrograde lymphatic flow.

A rare case is presented of Kaposi's sarcoma localized to the scrotum with history, and physical and laboratory findings. Excision of the scrotum with bilateral orchiectomy was performed, with uneventful recovery. Literature is reviewed of Kaposi's sarcoma originating in the male external genitalia.

A case of multiple adenocarcinoma arising from the kidney, bladder, and prostate is presented with a relevant discussion of the possible factors of pathogenesis. A staged approach of radical extirpative surgery is suggested.

Leiomyomas may originate from any anatomic location of smooth muscle in the genitourinary system but are uncommon neoplasms. Five unusual cases of leiomyomas arising from the renal pelvis, bladder, spermatic cord, and glans penis are presented. The leiomyoma arising from the glans penis in a three-year-old boy is the first case of a leiomyoma in that location noted in the literature. A review of leiomyomas from each genitourinary structure of origin is presented.

A five-year-old boy had an asymptomatic, periurethral, scrotal-perineal mass. An unusual associated urethral defect was subsequently discovered. The locally aggressive lesion was excised and urethroplasty accomplished. The histopathologic diagnosis proved to be plexiform neurofibroma. This is a forme fruste example of ectodermal dysplasia known as neurofibromatosis. I believe this is the first report of similar scrotal, perineal, or periurethral involvement in the syndrome.

Cholesterol determinations in morning urine samples were taken in 235 selected patients with a positive test for microscopic hematuria. Values ranged from 0.2 to 76.0 mg (median 5.5) in 23 patients with urologic malignancies and from 0.1 to 33.4 mg (median 1.1) in 38 patients with various benign diseases of the kidney or urogenital tract. In the 28 patients with urinary tract infections and 146 subjects without evidence of disorders of the kidney and the urogenital system, urinary cholesterol excretion was usually normal (0.1 to 1.9 mg; median 0.35). Using 1.0 mg urinary cholesterol per morning urine as a cutoff point, sensitivity for urologic carcinomas is about 80 per cent with a comparable high specificity of 90 per cent. Therefore, subsequent measurements of urinary cholesterol in populations with microscopic hematuria could define two groups, one with high prevalence and one with low prevalence of urologic malignancies. The less complicated colorimetric instead of gas-liquid chromatographic determination of urinary cholesterol can be recommended as a screening test for urologic carcinomas in populations with microscopic hematuria.

Tissue polypeptide antigen (TPA) is an oncofetal antigen found in human malignant tumors of various origins. We used radioimmunoassay to determine TPA levels in a total of 150 serum samples from 88 patients with different types of genitourinary cancers. The serum TPA level among cancer patients of all stages combined was higher than in normal healthy controls (p less than 0.05). However, when the patients with metastases were excluded from the analysis, the TPA titer was not significantly different from those of the normal controls. The difference in serum TPA between patients with local disease and patients with metastatic lesions was highly significant (p less than 0.0001). The serum TPA levels were significantly decreased in patients who responded to treatment; the levels were significantly increased in those who progressively became worse.

A case of extraosseous chondrosarcoma arising from the spermatic cord is reported and the literature reviewed. Chondrosarcoma arising from nonosseous tissue is rare, and only a handful of cases have been reported. However, unlike chondrosarcoma of bone, extraosseous myxoid chondrosarcoma behaves in a less aggressive fashion making the distinction between the two entities prognostically significant.