Penile paraffinoma after subcutaneous injection of paraffin. Treatment with a two step cutaneous plasty of the penile shaft with scrotal skin

OBJECTIVE

To report a rare case of penile paraffinoma caused by the subcutaneous or intra-urethral injection of foreign substances containing long-chain saturated hydrocarbons. These were injected in order to increase the penis size which generated a chronic granulomatous inflammatory reaction. This is a rare practice in the western world.

METHODS

We present the case of a 32-year-old Bulgarian male who presented with a two-year history of elastic, slightly painful penis swelling after subcutaneous liquid paraffin injection. The proposed treatment was excision of the affected tissue and penile reconstruction in a two-stage procedure.

RESULTS

The operative procedure was successful and the patient had good aesthetic and functional results. Paraffin and other materials injected into the penis can produce many complications. Foreign body granuloma, skin necrosis, penile deformity, chronic and unhealed ulcer, painful erection, and the inability to achieve a satisfactory sexual relationship are some of the resulting complications. Intralesional or systemic steroids have been used in primary sclerosing lipogranuloma resulting in the disappearance of the granuloma, but in our opinion the treatment of choice should be radical excision, and, if necessary, secondary reconstruction of the penis.

CONCLUSION

The injection of foreign substances to enhance penis size is currently an unjustifiable practice. However, it is still carried out, especially in Eastern Europe and Asia. In most cases surgical treatment is needed to treat the complications and the best modality seems to be radical excision together with follow-up.

[Multilocular cystic nephroma. A diagnostic and therapeutic challenge. Report of two cases]

OBJECTIVES

Multilocular cystic nephroma is a rare benign entity grouped among the cystic non genetic diseases, which usually presents with a clinical picture and radiological features indistinguishable from malignant neoplasias, making impossible to rule out malignancy preoperatively.

METHODS

We report two cases of multilocular cystic nephroma which were treated with different surgical attitudes despite their clinical and radiological similarities, because on the second case intraoperative pathologic study of the specimen was performed.

RESULTS

The diagnosis of multilocular cystic nephroma was confirmed in both cases, with the difference that radical nephrectomy was performed in the first case whereas the intraoperative study of the tumor in the second allowed to perform tumorectomy with renal parenchyma preservation.

CONCLUSIONS

We consider that in the presence of a multiloculated renal mass of complex appearance and benign clinical behavior, the intraoperative study of the tumor will avoid performance of radical surgery.

[The expression of p53 and c-erb-2 in transitional cell carcinoma of the kidney pelvis and ureter and its relation to tumor progression and survival]

OBJECTIVE

To evaluate P 53 and c-erb-2 overexpression as a prognostic factor for progression and survival in patients with renal pelvis and ureter tumors.

METHODS

Retrospective review of the medical records and pathology/immunohistochemical reports of 61 patients who underwent surgery for upper urinary tract urothelial tumors. Immunohistochemical studies were performed using the STREPTAVIDIN-BIOTIN-PEROXIDASE techniques with a LASAB kit (DAKO). Pearson's Chi square for 2 x 2 contingency tables and residues analysis were used for non continuous variables, with a confidence level of p < 0.05. COX multivariate analysis and survival curves were used for multiple variables association.

RESULTS

A higher P 53 overexpression was related with tumour dependent death (p < 0.001). These patients have their long term survival compromised. C-erb-2 overexpression is not statistically related to either proliferation or cancer specific death in upper urinary tract urothelial tumors.

CONCLUSIONS

In our series P53 overexpression has prognostic value in upper urinary tract urothelial tumors, but c-erb-2 did has not prognostic value.

[Personal and histopathological factors as prognostic variables in upper urothelial tumors undergoing surgery]

OBJECTIVE

To analyze the influence of personal and histopathological factors as prognostic variables in the evolution of upper urothelial tumors submitted to radical surgery.

METHODS

Multifactorial retrospective study of a series of 61 patients submitted to radical surgery for upper urinary tract transitional cell tumors. Patient habits and histopathological factors are analyzed. The statistical significance of the different factors was analyzed using the Pearson chi-square test for the qualitative variables, with analysis of the residuals and Kaplan-Meier survival curves and statistical validation with the Mantel Cox test. The level of significance was p < 0.05.

RESULTS

A statistically significant correlation was found for tumor-related death and pathological stage, positive lymphadenectomy and positive lymphadenopathy on the CT (p < 0.05). The presence or absence of a history of smoking was not available for all patients and was therefore not evaluable. The most frequent reason for consultation was hematuria (39%). Tumor growth was mostly of the papillary type (79%), localization was mostly in the renal pelvis (30%) and the most frequent procedure was nephroureterectomy without endoscopic detachment (60%).

CONCLUSIONS

The pathological stage and a positive lymphadenectomy or the presence of positive lymphadenopathies on the CT were found to be prognostic factors in urothelial tumors of the upper urinary tract.

[Intraureterocele transitional tumor synchronous with contralateral ureteral tumor: obstructive uropathy in panurothelial disease]

OBJECTIVE

To present a case of urothelial tumor inside a simple ureterocele with a coexisting contralateral tumor that caused bilateral obstructive uropathy.

METHODS

Follow-up evaluation of a 74-year-old male patient with superficial tumor of the urinary bladder diagnosed 4 years earlier, revealed renal failure and bilateral obstructive uropathy. The complementary tests showed a simple left ureterocele containing a lesion suggestive of a tumor and a right ureteral tumor.

RESULTS

After biopsy confirmed coexisting urothelial disease at 3 levels (intraureterocele, contralateral ureter and in situ carcinoma of the bladder), the patient was submitted to cystoprostatectomy, nephroureterectomy and en bloc segmental ureterectomy.

CONCLUSIONS

Multicentric synchronous urothelial tumors warrant a close and long follow-up of the entire urinary tract. Among the possible sites of presentation, few cases of tumors inside a ureterocele have been reported. The case described herein, with this uncommon site of presentation, is an example of panurothelial disease.

[Acute hematuria as first manifestation of bladder urothelioma in a 17-year-old adolescent]

OBJECTIVE

To report a case of urothelial tumor of the bladder in a 17-year-old patient that required emergency surgical treatment due to acute hematuria.

METHODS

The clinical history, anatomopathological and immunohistochemical findings are described.

RESULTS

A 17-year-old patient with no remarkable clinical history, consulted at the emergency services for gross hematuria of sudden onset that caused anemia and was refractory to conservative management. Patient evaluation disclosed a bladder lesion that required immediate resection via the transurethral approach to control bleeding. The pathological analysis demonstrated a grade I, Jewett stage 0, pTaN0M0 transitional cell carcinoma of the bladder.

CONCLUSIONS

Urothelial tumors of the bladder are uncommon in patients less than 40 years old. The case described herein is uncommon because of the patient's age and the form of presentation of the tumor, which required emergency surgical treatment. Follow-up and subsequent therapy should be based on the pathological characteristics of the tumor rather the age of the patient.