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Background: Bladder cancer is among the 5 most common malignancies worldwide. Patients with bladder cancer are closely followed with periodic cystoscopies and urine cytology analyses due to the significant risk of tumor recurrence. The UroVysion fluorescence in situ hybridization (FISH) test demonstrated higher sensitivity over urine cytology in detecting bladder cancer by most comparative studies., Methods: In the current study, the diagnostic usefulness of a combined cytology and FISH analysis approach was tested using the Duet automatic scanning system in patients with benign urine cytology who were being monitored for recurrent urothelial carcinoma or being assessed for various urologic symptoms., Results: By combining the benefits of conventional cytology with molecular diagnostics, a more sensitive detection of bladder cancer was attained. All patients who had positive cystoscopy concomitantly with urine sampling were detected by combined analysis. Additional patients that developed transitional cell carcinoma during a follow-up period of 24 months had a previous positive result on combined analysis. Only 2 patients with a negative combined analysis result presented with late disease recurrence (20 months and 22 months, respectively, after the negative test). Therefore, negative combined analysis was found to be predictive of a lack of disease recurrence for at least 12 months. In this timeframe, the overall sensitivity, specificity, negative predictive value (NPV), and positive predictive values of the combined analysis test were 100%, 65%, 100%, and 44%, respectively., Conclusions: Given the absolute sensitivity and NPV of the combined analysis test, the management of patients with a negative combined analysis result might be revised and allow for more flexible assessment and management of bladder cancer patients relying more on urine bound tests.

Aim: Merkel cell carcinoma (MCC) is an uncommon but potentially aggressive tumor. We describe a rare presentation of MMC of the upper lid., Methods: A 63-year-old male presented with a 3-month history of right upper lid fullness. Examination revealed a large multinodular mass protruding into the conjunctival aspect of the eyelid. An enlarged right submandibular lymph node was also noted., Results: An incisional biopsy was suggestive of MCC. Staged surgical excision with rapid paraffin sections was performed. The tumor cells were seen invading the tarsal plate and adjacent to the palpebral conjunctiva but not into the epidermis. MCC was confirmed using immunohistochemical stains and neuroendocrine markers (cytokeratins Cam 5.2, AE1/3, CK20, chromogranin, synaptophysin, and Leu 7). The lymph node biopsy was also confirmed as metastatic MCC. The patient was treated with postsurgical chemotherapy and radiotherapy, with no recurrence during a 6 months follow-up period., Conclusion: Although uncommon, periocular MCC may present as an atypical conjunctival multinodular mass.

Background: Sebaceous carcinoma (SC) is well known for its ability to masquerade clinically and histologically as a variety of periocular conditions resulting in a delayed diagnosis. We present a series of periocular SC cases and discuss the difficulties in histopathological diagnosis when this tumor presents with a Bowenoid pattern of intraepithelial spread., Methods: A retrospective case study of all patients with SC of the eyelid treated in our Hospital, from 1997 to 2004, was conducted., Results: Eight patients were identified (four females and four males). Seven cases involved the upper eyelid. Initial clinical diagnoses included blepharitis (three cases), blepharoconjunctivitis (one case), cicatrizing conjunctivitis (one case), and lid lesions (two cases). Histopathologically, 87.5% of cases were misdiagnosed as Bowen's disease (BD) on the initial biopsy. Six of these cases showed no invasive disease on the initial biopsy and were eventually found to be invasive SC on subsequent excisions. In one case, the tumor was wholly in situ. Delay in diagnosis ranged from 0 to 56 months., Conclusions: SC should always be considered in the histological differential diagnosis of any eyelid lesion which resembles BD, particularly if the upper eyelid is involved or if multivacuolated cytoplasmic clear cell changes are seen.

Background: Basosquamous carcinoma (BSC) is a rare tumor defined as a basal cell carcinoma (BCC) differentiating into squamous cell carcinoma (SCC). It is reported to have a high rate of recurrence with standard wide local excision. The aim of the current study was to report a large series of patients with BSC treated with Mohs micrographic surgery (MMS)., Methods: The prospective, multicenter case series included all patients in Australia treated with MMS for BSC, who were monitored by the Skin and Cancer Foundation Australia between 1993 and 2002., Results: Most of the 178 tumors (95.6%) were located in the head and neck area. Recurrent tumors occurred in 47.8% of patients. The tumors were diagnosed initially as BCC in 87.4% and as SCC in 12.0% of patients. Perineural invasion was recorded in 7.9% of patients with data available. Most of these (69.0%) were previously recurrent tumors. Of 98 patients who completed a 5-year follow-up period after MMS, 4 (4.1%) had disease recurrence., Conclusions: The low 5-year disease recurrence rate of BSC with MMS emphasized the importance of margin-controlled excision using MMS.

Background: Pure testicular teratoma in adults is a relatively rare malignant tumor with the ability to invade and metastasize. Pure teratoma generally is believed to be less aggressive and less likely to progress, to present in lower stages, and to have better survival rates then other forms of germ cell tumor. Consequently, clinical stage A patients with pure testicular teratoma commonly have been considered to be managed best by surveillance., Methods: A computerized database search identified 41 patients presenting to Indian University with pure teratoma in the orchiectomy specimen. These patients were further subdivided into four groups based on clinical stage, as follows: Group I, 18 patients with clinical Stage A disease; Group II, 4 patients with clinical Stages A-B1 disease based on questionable computed tomography findings; Group III, 3 patients with clinical Stage B1 disease; Group IV, 16 patients with advanced stage (B3-C) disease. The experience with these patients was reviewed., Results: The overall risk of lymph node metastasis in retroperitoneal lymph node dissection (RPLND) and the risk of relapse after RPLND for patients with low stage pure testicular teratoma (groups I-III) were 40 and 16%, respectively. In patients with clinical Stage A teratoma, the risk of retroperitoneal metastasis in RPLND was 16.7% and the relapse rate was 11.1%. In addition, nearly 37% of referred patients with pure teratoma presented with advanced disease., Conclusions: These data provide additional confirmation of the metastatic potential of pure testicular teratoma. The proper management of the adult clinical stage A patient with primary pure teratoma of the testis should not necessarily differ from the management of any other histologic type of nonseminomatous testicular tumor. Accordingly, histologic diagnosis of pure teratoma should not mandate surveillance. Instead, patients must be given adequate information regarding management options, as are all other patients presenting with clinical Stage A nonseminoma.

Background: Although radical cystectomy is accepted by most urologists as the treatment of choice for invasive carcinoma of the bladder and age alone is not considered a contraindication for radical surgery, many consider radical major operations to be unsuitable for elderly patients., Methods: The authors compared the results of radical cystectomy in 42 elderly patients to those in patients 69 years old or younger and to a group of 21 elderly patients, matched by stage of disease and severity of medical problems, who received alternative treatment., Results: The overall operative mortality rate was 6.3% (seven patients). Three (4.3%) postoperative deaths in the younger group and four (9.5%) deaths among elderly patients were recorded. The operative morbidity and mortality did not differ significantly between those two groups (P = 0.1). Among the patients who received alternative therapy, 13 (61.9%) died within the first 6 months, and only 3 survived more than 12 months. Morbidity was encountered in 97% of these patients., Conclusions: The authors showed that radical cystectomy is a relatively safe procedure for elderly patients. The elderly patient who is thought to be unsuitable for surgery not only is deprived of his right to definite curative therapy but also is exposed to higher morbidity and mortality and worse quality of life than are those who undergo operations. The authors conclude that it is unjustified to avoid radical cystectomy in the elderly population on the basis of age alone.

Increased levels of serum alkaline phosphatase (ALP) (E.C.3.1.3.1.) were observed in 25 patients with various urological conditions involving the kidneys: malignancy, complicated nephrolithiasis, and surgical and percutaneous manipulations. Other possible sources for increased ALP level, mainly hepatic and osseous, were excluded by history, laboratory tests, and liver and bone imaging. Studies of isoenzymes of ALP did not show a distinctive pattern. ALP levels returned to the normal range by treating the underlying lesions involving the kidney: nephrectomy, complete removal of stones, or removal of nephrostomy. The increase in serum ALP activity may be derived from the injury to the brush border membrane of the renal tubular cells. Renal function impairment and contrast media induced nephrotoxicity may also be responsible for the increased serum ALP. Serum ALP may be a marker for involvement of the kidneys in pathological processes and an indicator of complete treatment. This clinical observation is worthy of further study.