New Insights into Disease and Pathogen Research Vol. 4

Less than 200 cases of para-testicular liposarcoma (PTL) have been reported. PTL may present with painless or painful intra-scrotal or inguinoscrotal mass of long duration or recent onset but the most common presentation is a painless mass. Para-testicular liposarcomas does mimic various common intra-scrotal and inguinoscrotal masses, some of which include: inguinal hernia, lipoma, fibroma, fibrosarcoma, leiomyoma, leiomyosarcoma, rhabdomyosarcoma, various types of testicular tumours and other non-common intra-scrotal lesions. The symptoms tend to be non-specific. PTLs tend to be unilateral but bilateral cases have been reported. Radiology imaging would define the features of the lesion. Fine needle aspiration cytology could establish the diagnosis but the diagnosis tends to be established by pathology examination of the excised specimen of the tumour which would show spindled-tumoral cells with atypical features and mitotic activity and lipoblasts. Immunohistochemistry staining studies of the tumour would exhibit positive staining for MDM2, CDK4, S100 and STAT6. PTL is treated by trans-inguinal radical orchidectomy ensuring complete excision of the tumour with tumour-free excision margin plus adjuvant radiotherapy plus / minus adjuvant chemotherapy for localized disease. For metastatic and advanced lesions, radical trans-inguinal orchidectomy plus radiotherapy plus chemotherapy should be undertaken. New chemotherapy options need to be developed to effectively destroy para-testicular liposarcoma tumour cells. All excised innocuous looking intra-scrotal masses that should be submitted for histopathology examination in order not to misdiagnose PTL as benign lipoma. Generally the prognosis of localized PTL tends to be good following radical orchidectomy with complete excision of tumour.

Background: Adenocarcinomas of the prostate gland are commonly encountered globally but other uncommon variants of carcinoma of the prostate are sporadically encountered including primary sarcomatoid carcinoma of the prostate (PSCP).

Aims: To review the literature of PSCP.

Methods: Various internet search engines were searched for literature on PSCP.

Literature Review: About 100 cases of PSCP have so far been reported. PSCP may develop de novo or may emanate following hormonal therapy or radiotherapy for adenocarcinoma of prostate; PSCP may present with LUTS, haematuria, perineal/back pain. Histology of prostate biopsy tends to show a biphasic tumour which has an adenocarcinoma component as well as a second component which is a clearly recognizable type of sarcoma component which could be angiosarcoma, chondrosarcoma, leiomyosarcoma, osteosarcoma or rhabdomyosarcoma. With regard to immunohistochemistry, the epithelial component of sarcomatoid carcinoma of prostate stains positively for cytokeratin and PAP and negatively for PSA; the sarcoma component stains negatively for PSA, EMA and keratin. There is no consensus opinion on treatment. TURP has been performed for lower urinary tract obstruction symptoms and urinary retention, radical prostatectomy, pelvic exenteration, and chemotherapy are some of the treatments employed. A number of cases of PSCP had presented at advanced stages of the disease. PCSP is aggressive with poor prognosis; however, early aggressive surgery in some cases had resulted in survival.

Conclusions: A multi-centre trial is required to determine the best treatment option for PSCP. Perhaps patients with progressing prostate cancer following radiotherapy of castrate resistant prostate cancer should have repeat prostate biopsies to determine if they have developed dedifferentiation into PSCP or other variants of prostate cancer and to try cases of PSCP on chemotherapy as a trial.

Background: Primary synovial sarcoma of the prostate gland (PSSP) is rare and most clinicians would be unfamiliar with its biological behaviour.

Aim: To review the literature on PSSP.

Methods: Various internet data bases were searched.

Literature Review: PSSP is extremely rare with less than 10 cases reported; affects both young and older men; its diagnosis may be made incidentally following histological and cytogenetics examinations of prostate biopsy or prostatectomy specimens which show: A specific chromosomal translocation t(X; 18; p11; q11); Uniform spindle and oval cells which have formed interlacing fascicles that mimic fibrosarcoma. The compact fascicles of tumour cells focally alternate with hypo- cellular myxoid tissue which mimic peripheral nerve sheath tumours. Focal pericytomatous pattern of polygonal cells arranged around dilated, thin-walled blood vessels. PSSP tumour cells on immunohistochemical staining, stain positively with: Vimentin (most of the cells), EMA (focal positivity), Bcl-2 (strong positivity), CD99 (strong positivity), E-cadherin (strong positivity), cytokeratin (focal positivity), CD 56 and TLE/TLE1. There is no consensus opinion on treatment of PSSP which is an aggressive tumour with poor outcome. However, an aggressive radical surgical treatment by radical prostatectomy or pelvic exenteration plus or minus adjuvant therapy would appear to be the best treatment option with curative intent to help improve prognosis. Some patients with PSSP may need palliative and supportive treatment through a multi-disciplinary team approach.

Conclusions: PSSP is a rare aggressive tumour with poor prognosis. All cases of PSSP should be entered into a multi-centre trial to ascertain the best treatment option that would improve the prognosis and to further assess its biological behaviour.

Aims: The aim of this study was to determine the dermatoses associated with gender in this geographical area.

Study Design: A descriptive cross-sectional survey.

Place and Duration of Study: Dermatology Clinics of OAU Teaching Hospitals’ Complex (OAUTHC), Ile-Ife, Osun State, Nigeria between October 2009 and September 2012.

Methodology: Recruitment of consecutive patients presenting with skin diseases was done on two days in a week during the study period. Demographic data on age, gender and symptoms were taken, and the diagnosis of presenting skin conditions documented. The results were analyzed using Statistical Package for Social sciences (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc). The Odds ratio of dermatological diseases for both genders was obtained using WINPEPI 11.0 with 95% confidence interval and p value of 0.5 signifying a significant relationship between the dermatosis and gender type.

Results: Patients studied were 1013, aged 18-90 years, and 55% females. The male gender was significantly associated with acne keloidalis nuchae, folliculitis/carbunculosis, seborrhoeic eczema, lichen simplex chronicus, and Hansen’s disease. Drug reactions, seborrhoeic keratosis, miliaria rubra, and papular urticaria were, however, the only significant diseases in females.

Conclusion: Certain skin diseases are indeed significantly associated with gender. For some of these diseases, differences in the biophysical profile of the male and female have been found responsible. Other factors such as occupation predisposing to gender predilection will need to be further elucidated.

Primary angiosarcoma of the prostate (PASOP) is a very rare tumour which most clinicians have not encountered and may be unaware of. Literature of PASOP was reviewed by obtaining information from various internet data bases including: Google, Google Scholar, Educus and PUB Med. Less than 20 cases of PASOP have been reported. PASOP may present in a male child or adult with lower urinary tract symptoms, dysuria, haematuria, pain and constipation. There may be in some cases a history of prior radiotherapy for adenocarcinoma of prostate. Diagnosis is based upon histological examination of prostate biopsy specimens which tend to reveal: Proliferative vascular channels that are lined by atypical multi-layered or atypical solid endothelial cells, variable pleomorphic tumour cells ranging from spindle cells to large/plump cells; nuclei which are large and pleomorphic and which contain clumped chromatin and prominent nucleoli; mitotic figures of which some may look atypical are frequently seen. PASOPs on immunohistochemical staining tend to stain positively for CD34, Factor 8 (Factor VIII), Vimentin. PASOPs on immunohistochemical staining tend to exhibit negative staining for PSA, Keratin and S-100. Surgical resection with surgical margins that are clear of tumor has been shown to be the treatment associated with a chance of long-term survival but a number of reported cases of PASOP at the time of initial diagnosis had presented with metastatic disease or locally advanced disease and curative surgery with clear surgical margins has been impossible. Various adjuvant therapies had been reported but on the whole the prognosis has been poor. There is on the whole no consensus opinion on the best management options for all stages of the disease. PASOP is a rare aggressive disease. Clinicians should report cases of PASOP they encounter and should enter them into a multi-centre trial to find the best treatment option. Perhaps if patients who develop relapse disease who had previously undergone radiotherapy for prostate cancer undergo further biopsies of prostate may be new cases of PASOP would be diagnosed in the new biopsy specimens and this could illustrate that PASOPS are not as uncommon as used to be believed.

Background: Primary squamous cell carcinoma of renal pelvis/kidney (PSCCRP/K) is rare with controversies regarding its histogenesis.

Aim: To review the literature.

Methods: Various internet data bases were searched.

Literature Review: Few cases of PSCCRP/K have been reported with only three cases of PSCC of the renal parenchyma without involvement of renal pelvis. Some PSCCRP/Ks have been associated with renal calculi, chronic infections, vesicoureteric reflux. Some cases had developed many years following successful percutaneous nephrolithotomy; a case was reported many years after curative radiotherapy for testicular tumour. The tumours are initially diagnosed in advanced stages; generally the prognosis has been poor following nephrectomy/nephrouretectomy. Conventional radiology imaging features of the disease are non-specific and cannot differentiate the lesion from other tumours or xanthogranulomatous pyelonephritis. Diagnosis is based upon strict histopathological criteria of the microscopic characteristics of the tumour. Primary tumour elsewhere should be excluded with radiological imaging. PSCCRP/K should be suspected when a renal/renal pelvis mass is found with a history of chronic or past stone disease treatment. Perhaps if patients who have undergone treatment for kidney stones are carefully followed-up with radiological imaging, (for example, ultra-sound-scans and/or MRI and when eventually required a CT scan properly indicated and performed) for a long time, PSCCR/Ks may be diagnosed at an early stage of the disease in order to provide early curative treatment.

Conclusions: PSCCRP/Ks have been reported sporadically and a number of them have been associated with renal calculi and chronic infections of the urinary tract. These malignancies on the whole are initially diagnosed in advanced stages and hence associated with poor prognosis. Histopathology examination of the lesion so far is the definite way to confirm the diagnosis. PSCCRP/K should be considered a differential diagnosis when a patient is found to have a renal / renal pelvis mass and a history of treatment for renal pelvis calculi, or chronic inflammations.