Biomedical subjects
A Houlgatte
Publications and source records attributed to A Houlgatte.
[Dedifferentiation of mature teratomas secondary to testicular cancer: report of 2 cases].
The authors report two cases of adenocarcinomatous dedifferentiation of a recurrent mature teratoma arising 3 and 20 years after the initial resection. This is a rare event, occurring after macroscopically or microscopically incomplete resection of a mature teratoma. The nature of this recurrence was difficult to determine prior to histological examination. However, PET scan suggests the diagnosis of malignant teratoma in the presence of increased uptake by the lesion. These tumours have a poor prognosis. Treatment consists of complete resection of the tumour mass. The possibility of long-term malignant dedifferentiation of a teratoma therefore requires prolonged and regular life-long surveillance of patients presenting a mature teratoma after chemotherapy for non-seminomatous germ cell tumour of the testis.
[Verrucous epidermoid carcinoma of the bladder unrelated to schistosomiasis].
The authors report two cases of papillomatous squamous carcinoma of the bladder unrelated to schistosomiasis. Both patients were treated by endoscopic resection. The staging assessment comprised thoraco-abdominopelvic computed tomography. A papillomatous squamous carcinoma of the bladder was detected in both cases: one was classified as pT2 G1 N0 M0 and the other as pT1 G1 N0 M0. Recurrence was rapidly observed, at the first follow-up cystoscopy. The tumour initially classified as pT1 subsequently underwent transformation to sarcomatoid carcinoma with peritoneal metastases. Papillomatous squamous carcinoma of the bladder, a rare squamous cell carcinoma, is a well differentiated tumour with an exclusively local and regional development. The prognosis is determined by the degree of tumour invasion, with a high local recurrence rate. The prognosis of invasive tumours is identical to that of conventional squamous cell carcinoma. Therapeutic management is poorly defined, but the only curative treatment appears to be radical cystectomy.
[Incidental disclosure of juxta-hilar mass in the left kidney].
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Fibrous pseudotumor of the epididymis: imaging and pathologic correlation.
We report the case of a 25-year-old man who presented a fibrous pseudotumor of the epididymis, a rare focal location of nodular and diffuse fibrous proliferation. We provide the ultrasonographic and MRI findings with pathologic correlation.
[Current chemotherapy of locally advanced or metastatic bladder tumors].
Standard chemotherapy of transitional cell carcinoma of the bladder is actually the combination of cisplatine, methothrexate, vinblastine and doxorubicine (MVAC). Although a high response rate, long term survival are rarely observed. More effective agents without toxicity are necessary. Several agents have demonstrated activity alone or in combinations. Combinations regimens use, paclitaxel, gemcitabine and Gallium nitrate, who prove activity alone or in combination with cisplatine or carboplatine, with a response rate of 40 to 70% in patient with visceral localisations. The optimal regimen is not yet determined.
[Surgical treatment of priapism: experience of 56 cases in an African setting].
Since priapism is uncommon, treatment is controversial and difficult. In this article we describe a practical, well-documented approach for management of priapism in countries with a high incidence of sickle cell disease. This approach is based on our experience including a total of 56 black patients (49 adults and 7 children) as well as on the results reported in the literature. The patients in our series were examined and treated by the same physician over an 18 year period in various African countries, i.e., Burkina (n = 8), Chad (n = 12), Gabon (n = 19), and Niger (n = 17). Etiologies and pathophysiology are reviewed. In all cases, surgical treatment involved diversion from corpora cavernosa. In the 51 cases with follow-up periods of 3 months or longer, results were considered as excellent in 17 cases (33 p. 100), partial in 5 (9.8 p. 100), and unsuccessful in 29 (56.8). Since 1984, needle drainage with a unilateral transglandular cavernosal-spongiosum shunt based on the technique described by Al Ghorab's has led to better results with immediate detumescence in 80 p. 100 of cases and a long-term success rate of 52 p. 100 (13/25 cases with sufficient follow-up). Except in cases involving sickle cell anemia in which concomitant medical treatment of priapism can be useful, immediate surgical treatment is the only technique effective in avoiding secondary impotence, which was common in our series (58.6). Our p. 100 needle drainage technique appears to be the method of choice for simplified achievement of a unilateral transglandular cavernosal-spongiosum shunt.
[Progression of stage I non-seminomatous germ cell tumors during surveillance. Role of positron emission tomography].
Surveillance is one of the options proposed in the management of stage 1 non-seminomatous germ cell tumours when there is only a low risk of progression. No consensus has yet been reached concerning the modalities of this surveillance and several protocols are available, including the CCAFU protocol. The presence of recurrences in this population at low risk of progression, estimated to be 5%, accounts for the continuing research for more precise predictive factors of occult metastases. Although several studies appear to indicate a useful predictive value for some of these factors, their application in clinical practice still appears to be difficult. PET metabolic imaging (positron emission tomography) could constitute a new approach to staging of these tumours, allowing the detection of tumour sites by an increase of carbohydrate metabolism of malignant cells. However, no study is yet available to define the real place of this technique.
Translocation (X;1) associated with a nonpapillary carcinoma in a young woman: a new definition for an Xp11.2 RCC subtype.
We report a translocation (X;1)(p11.2;q21) associated with a nontubulopapillary renal cell carcinoma in a 23-year-old woman. To our knowledge this the first report of such an association. A review of the previously published cases of renal cell carcinoma with t(X;1) and its cytogenetic variants with Xp11.2 anomalies is included. The role of this karyotype abnormality as a clinical marker is discussed. The Xp11.2 abnormality could be a primary abnormality characterizing a particular type of RCC appearing in children and young adults of both sexes and in which the histological aspect is not specific.
Paternity in a patient with seminoma and carcinoma in situ in a solitary testis treated by partial orchidectomy.
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[Benign neurogenic tumors of the lumbar plexus. Role of the enucleation procedure].
Benign neurogenic tumours originating from lumbar plexus or roots are rare. Two cases are reported. Resection, often possible with another localisation, may result in neurological deficit in these cases. Enucleation, the best choice, is not always feasible. Hollowing-out is therefore a procedure worth understanding.
Influence of free-to-total prostate specific antigen variability on the early diagnosis of prostate cancer: a comparative study of three immunoassays.
OBJECTIVE: To compare three immunoassays for total prostate specific antigen (tPSA), free PSA (fPSA), free-to-total PSA ratio (f/tPSA), and the f/tPSA thresholds for optimal differentiation between benign prostatic hypertrophy (BPH) and prostate cancer in 141 consecutive patients referred for prostatic disease. PATIENTS AND METHODS: The study included 43 patients with prostate cancer and 98 with BPH, all confirmed histologically. PSA levels were assessed using the following assay kits just before histological analysis of the prostate; Hybritech (Tandem-R PSA, normal values, NV, < 4 ng/mL, and Tandem-R free PSA), Cis Bio (PSA-RIACT, NV < 2.5 ng/mL and fPSA-RIACT) and Immunocorp (PSA-IRMA, NV < 4 ng/mL and Free PSA-IRMA). The results were assessed to determine the sensitivity, specificity and threshold values of the different assays to differentiate patients with BPH and cancer. RESULTS: The mean tPSA and f/tPSA ratio were statistically different in assays with different NVs. The mean fPSA values differed significantly between the Hybritech and Cis Bio, between the Hybritech and Immunocorp but not between the Cis Bio and Immunocorp assays. With receiver operator curve analysis, there were no statistically significant differences among the three immunoassays in f/tPSA (0.72 for Hybritech, 0.73 for Cis Bio and 0.64 for Immunocorp) or between the tPSA and fPSA curves for each manufacturer. With the sensitivity fixed at 90%, different f/tPSA thresholds were defined (0.22, 0.34 and 0.25 for Hybritech, Cis Bio and Immunocorp, respectively). The specificities (i.e. the percentage of unnecessary biopsies spared) were 22%, 21% and 31%, respectively (not significantly different). CONCLUSION: Each immunoassay could be used to distinguish prostate cancer and BPH at different f/tPSA thresholds, with 21-30% of unnecessary biopsies spared. There was no difference in overall performance among the different assays. Further studies are needed to better define the exact use of the f/tPSA ratio in the routine diagnosis of prostate cancer.
[Solitary fibrous tumor of the seminal vesicles: apropos of a case].
Solitary fibrous tumours constitute a rare disease, which has never previously been described in the seminal vesicles. We report a case of solitary fibrous tumour of the right seminal vesicle in a 53-year-old man. The diagnosis of seminal vesicle tumour was based on transrectal ultrasonography and MRI. The histological diagnosis was established after surgical resection of this tumour. The small biopsy samples and the heterogeneous appearance of these lesions make it difficult to establish the diagnosis on biopsies alone. The surgical attitude to solitary fibrous tumour of the seminal vesicle depends on the clinical features and the course of the lesion.
[Survival and quality of life of patients with testicular cancer].
Cisplatin has revolutionized the prognosis of testicular cancers. Stage I non-seminomatous germ cell tumours can be cured in 98% of cases; adjuvant therapy, chemotherapy or lymph node dissection, is recommended in high-risk tumours, while surveillance is indicated in tumours with a low risk of recurrence. Good prognosis metastatic non-seminomatous germ cell tumours are cured in almost 80% of cases at the cost of well tolerated chemotherapy, 3 BEP or 4 EP. The morbidity of lymph node dissection has been markedly decreased by means of various techniques of preservation of all or part of the sympathetic and lumbar contingent. Resection of residual masses after chemotherapy for metastatic non-seminomatous germ cell tumours is still recommended in the majority of cases. Stage I seminomatous germ cell tumours are cured in 98% of cases by 25 Grays of lumbo-aortic radiotherapy. Screening for carcinoma in situ in the contralateral testis to the primary tumour is controversial, but is recommended in the case of lowering of a maldesended testis after the age of puberty. Future paternity is a major concern in tumours of young adults, most of which are cured.
[Metastatic pure seminomas of the testicle: role of chemotherapy].
40% of testicular tumours are seminomatous tumours. The low mass tumours (LMT) (stages IIA and IIB of the Royal Mardsen Hospital classification) are usually treated by radiotherapy and the high mass tumours (HMT) (stage IIC, III and IV) by chemotherapy. Chemotherapy regimens are platinum-based polychemotherapy. We report 9 cases of seminomatous testicular tumours (4 LMT and 5 HMT) treated by chemotherapy (BEP modified or CBDCA-etoposide regimens), three courses, with one supplement course if necessary and surgery if residual masses are more than 3 cm long. The rate of complete remission are 100% for LMT and 60% for HMT. This could be an indication to treat in addition with orchidectomy the LMT with chemotherapy and not with radiotherapy (standard-gold) which is more toxic.
[Value of detection of carcinoma in situ in conservative surgery of germ cell tumors of the testis].
OBJECTIVE: It is currently proposed to perform tumour enucleation in mono-orchid patients presenting with a small germ cell tumour, in order to preserve physiological endocrine function. However, this conservative surgery must be accompanied by treatment of any carcinoma in situ lesions present in the remaining testicular parenchyma. MATERIAL AND METHODS: The presence of carcinoma in situ was investigated in 35 patients with germ cell tumour of the testis on samples obtained from the presumably healthy pulp of the orchidectomy specimen, adjacent to and away from the tumour. Samples away from the tumour were performed according to principle of surgical testicular biopsy. Histological examination also concerned the tissue situated in contact with the tumour. RESULTS: 25 patients (74.22%) presented intratubular germ cell dysplasia in the testicular parenchyma presumed to be healthy. These lesions were always concomitantly observed on samples performed adjacent to and away from the tumour. It was observed more frequently in seminomas, but was also observed in other histological forms. CONCLUSION: Because of the diffuse nature of carcinoma in situ in germ cell tumours of the testis, pulp samples adjacent to the tumour are sufficient to ensure the diagnosis during conservative surgery. Carcinoma in situ is currently treated by local radiotherapy.
Twenty-year experience with jejunal conduits.
OBJECTIVES: To assess the results of jejunal conduit urinary diversion, with particular attention to electrolyte imbalance and long-term renal function. METHODS: From 1976 to 1994, 50 patients underwent urinary diversion using a short jejunal loop (10 to 12 cm) placed transperitoneally. Of these patients, 18 received pelvic irradiation before diversion. Renal function and configuration of the upper urinary tract were assessed by creatinine clearance and excretory urography. RESULTS: Median follow-up was 26 months (3 to 204). Of 50 patients, 22 had a follow-up more than 5 years later (median 86 months). Eight patients (16%) underwent 10 revision procedures postoperatively. Late complications related to urinary diversion included renal calculi (12%), parastomal hernia (6%), pyelonephritis (4%), ureterojejunal obstruction (4%), and stomal prolapse (2%). Electrolyte imbalance occurred in 2 patients (4%) and was easily corrected by 4 g sodium bicarbonate. No significant decrease in creatinine clearance (P = 0.6) was found in 22 patients with a follow-up of more than 5 years; however, of these patients, 2 had a decrease in creatinine clearance of greater than 20%, due to ureterojejunal obstruction. Of 42 ureterorenal units, hydronephrosis occurred and increased in 1 and 2 cases, respectively, and renal scarring occurred and progressed in 2 and 2 cases, respectively. CONCLUSIONS: Urinary diversion using a short length of jejunum placed transperitoneally is a reliable procedure and gives good long-term renal function. Electrolyte imbalances are rare. Moreover, jejunal conduit can be used in almost all situations, especially after pelvic irradiation.
Ureteropelvic junction avulsion due to nonpenetrating abdominal trauma treated with caliceal ureterostomy.
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