Lymph node metastasis from carcinoma in situ of the penis: a case report

Occult urothelial carcinoma with mediastinal metastasis: A case report

Occult urothelial carcinoma (UC), particularly with mediastinal metastases, is an uncommon clinical occurrence. The present study describes the unusual case of a 70-year-old male patient who developed mediastinal metastases from an occult UC. Histological evaluations and immunohistochemical features of the mediastinal tumor were indicative of UC; however, extensive imaging failed to identify the primary urological lesion. The findings suggest that mediastinal metastases from UCs, despite their rarity, should be considered in cases where patients with mediastinal tumors exhibit chest-related symptoms. Prompt pathological examinations are crucial for ascertaining the nature and origin of the tumor. Moreover, individualized treatment should be performed in strict accordance with the established oncology guidelines.

Controversies in ilioinguinal lymphadenectomy

Patients with penile cancer who are proven to have negative inguinal lymph nodes have an excellent prognosis. Furthermore, patients with small-volume inguinal node involvement can often be cured by surgery alone. Lymphadenectomy has clear survival benefits for patients when applied to those with lymph node metastasis. However, the current morbidity of the standard technique of lymphadenectomy is an impediment to its universal application, and innovative strategies to reduce the morbidity of staging/treatment that do not compromise oncologic control must be developed and standardized. The optimal integration of multimodality therapy to improve survival in advanced disease will occur only through collaborative studies between centers with significant patient volume, which would be facilitated through the development of regional referral centers.

A rare case of penile cancer in situ metastasizing to lymph nodes

Penile carcinoma in situ, or Queyrat's erythroplasia, is a rare condition of the glans penis. This lesion has been associated with invasive squamous cell carcinoma; however, metastasis without an invasive component is extremely rare. There have only been 2 documented cases with metachronous metastases. We report a third case in which metastases were diagnosed at presentation. The patient was a 51-year-old man who presented with a glans penile lesion and bilateral inguinal masses later determined to be carcinoma in situ with metastases to the inguinal and pelvic lymph nodes. He subsequently underwent a partial penectomy and lymphadenectomy followed by adjuvant chemotherapy and radiation. This case is discussed, along with a brief review of the literature.

Squamous cell carcinoma of penis presenting as groin metastasis 3 years before the primary

A 78-year-old patient who developed bilateral inguinal node metastatic squamous cell carcinoma, more than 3 years before the primary penile carcinoma declared itself, is presented. An exhaustive multispeciality search for the primary including a circumcision proved fruitless. A review of the relevant literature is summarised.

The role of lymphadenectomy in penile cancer

In patients with squamous carcinoma of the penis, the presence and extent of metastases involving the inguinal nodes are the most important factors predictive of survival. Favorable prognostic indicators of cure in surgically treated patients in whom metastases develop include: (1) minimal nodal disease, (2) unilateral involvement, (3) no evidence of extranodal extension of cancer, and (4) absence of pelvic nodal metastases. Prophylactic lymphadenectomy in select patients at high risk for metastasis seems reasonable in lieu of prospective randomized trials because novel procedures have significantly decreased the morbidity of surgical staging. Patients with poor prognostic indicators either before or after surgery should be considered for multimodal therapy.

Natural history, management, and surveillance of recurrent squamous cell penile carcinoma:

For men with penile carcinoma, surveillance strategies may be tailored to the risks of local and regional recurrence, which vary according to the pathologic characteristics of the primary tumor and the modalities employed for local therapy (phallus sparing or extirpative) and regional therapy (surveillance or lymphadenectomy). Men at a higher risk for local or regional recurrence who should have more rigorous follow-up include those (1) treated with phallus-sparing strategies such as laser ablation, topical therapies, or radiotherapy; (2) patients with clinically negative inguinal lymph nodes who are managed without lymphadenectomy despite high-risk primary tumors (pT2-3, grade 3, vascular invasion); and (3) those with lymph node metastases after lymphadenectomy. Good candidates for less-stringent surveillance include patients with low-risk primary tumors (pTis, pTa, pT1, grades 1-2) and those with negative inguinal nodes after lymphadenectomy whose primary tumors were managed with partial or total penectomy.

Surgical management of intrinsic sphincter deficiency in women

The past decade has witnessed significant changes not only in our understanding of intrinsic sphincter deficiency, but also in our surgical approach to this problem. It became evident that the patient's medical condition, expectations, and degree of incontinence should define the approach in order to make the greatest impact on quality of life. The present review describes the current concepts and surgical approaches to intrinsic sphincter deficiency, namely slings, injectables, and artificial sphincters.

Needle suspension procedures: past, present, and future

This article reviews the history, evolution, and future of transvaginal needle suspension procedures for stress urinary incontinence. Although numerous technical modifications to the original Pereyra transvaginal needle suspension procedure have been described, the true success rates of these procedures are difficult to ascertain. In general, outcomes reported in the literature are variable, and few long-term studies exist. Only the results of well-designed, prospective, and long-term studies will determine whether recent advances in patient selection and continuing technical modifications will improve the outcome of bladder neck suspension procedures.

Proper diagnosis: a must before surgery for stress incontinence

Stress urinary incontinence is just one of many possible reasons for incontinence in a female patient. It is important to determine the exact etiology of the urinary incontinence because successful treatment depends on an accurate diagnosis. Many additional factors such as age, level of activity, presence and degree of pelvic prolapse, detrusor abnormalities, and coexisting medical conditions must be considered during the incontinence evaluation. The physical examination should assess urethral mobility and genital prolapse abnormalities. Bladder storage abnormalities such as poor compliance are accurately assessed using current urodynamic methods, but detrusor control abnormalities, such as detrusor instability, are not. The urodynamic evaluation is directed toward identifying and quantifying urinary leakage attributable to excursions of abdominal pressure utilizing abdominal (Valsalva) leak-point pressure testing. A focused evaluation allows the appropriate operative procedure to be selected, yielding optimal long-term results.