Primary malignant lymphoma of the urinary bladder is very rare. Less than 100 cases have been reported; most are B-cell lymphomas. We report a case of primary T-cell lymphoma of the urinary bladder in a patient with a history of schistosomiasis. The patient is a 52-year-old man with suprapubic pain and hematuria. Examination revealed a large suprapubic mass. Computed tomography scan of the pelvis showed a large lobular mass occupying the urinary bladder. No pelvic or abdominal lymphadenopathy was noted, and results of metastatic workup were negative. The patient underwent a transurethral biopsy of the bladder mass that revealed a diffuse large cell lymphoma that was negative for the B-cell marker L-26 (CD 20) and positive for the T-cell marker CD-3. Polymerase chain reaction studies of the paraffin-embedded tissue revealed rearrangement of the T-cell receptor gamma gene. The patient was administered cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOPP) chemotherapy and currently is being treated. This case represents, to our knowledge, a very rare primary lymphoproliferative neoplasm of the urinary bladder that might represent an unusual immune response to schistosomiasis.
The incidence of prostatic carcinoma in the Kingdom of Saudi Arabia is low despite a high saturated fat diet in recent years. This finding contradicts most western clinical studies, which indicate a positive association of a high fat diet with prostatic carcinoma.
The incidence of prostatic carcinoma in the Kingdom of Saudi Arabia is low despite a high saturated fat diet in recent years. This finding contradicts most western clinical studies, which indicate a positive association of a high fat diet with prostatic carcinoma.
AH Kardar, A Tulbah, A Peracha, T Merdad, A Al-Mathami, Primary Carcinoid Tumor of Testis. 1997; 17(2): 223-225 Carcinoid tumors are rather uncommon and about 85% of them occur in the appendix or ileocecal region. When they occur outside the GI tract, they are usually metastatic. A total of 43 cases of pure primary testicular carcinoid tumor have been reported. 1 We report a case of carcinoid tumor of the testis, the diagnosis of which was confused by the FNA diagnosis of Leydig cell tumor, another uncommon type of testicular neoplasm. Verification of the diagnosis was done by immunohistochemistry and electron microscopy. To our knowledge, this is the first case of primary carcinoid tumor of the testis reported from the Middle East.
Case ReportA 26-year-old Saudi male student was referred to our hospital with the diagnosis of Leydig cell tumor of the left testis. The patient had presented to an outside hospital with a three-month history of a painless swelling of the left testis. Ultrasound examination revealed the presence of a localized area of suspicious hypoechogenicity and FNA of the lesion was interpreted as a Leydig cell tumor. On examination, we found his left testis to be moderately enlarged in size and hard in consistency without tenderness. The other testis was normal and clinically there were no signs of abdominal metastases and no gynecomastia was found. A left radical orchiectomy was carried out through a groin incision. Tumor markers sent preoperatively (beta human chorionic gonadotrophin, alphafetoprotein, dehydroepiandrosteindione, androsteindione) all came back as normal. Histopathology of the testis was reported as carcinoid tumor of the testis and the margins were free of tumor. There was no history of symptoms of carcinoid syndrome. We performed quantitative estimation of 5-HIAA, gastrointestinal contrast study, chest x-ray and CT of the abdomen. These studies were all normal and there was no evidence of other primary or metastatic carcinoid tumor.Grossly, the tumor measured 4.5 cm in maximum dimension. It was well demarcated from the surrounding uninvolved testis, solid and yellow-tan in color (Figure 1). The spermatic cord and epididymis were normal.Histologically, the tumor was well demarcated from the surrounding testicular parenchyma. The tumor cells were arranged in nests, tubules and trabeculae separated by delicate fibrovascular stroma (Figure 2). The cells were round or polygonal and had eosinophilic granular cytoplasm. The nuclei were round and uniform with evenly dispersed granular chromatin. Focal nuclear pleomorphism was noted. Occasional mitoses were encountered. Immunoreactivity for synaptophysin, chromogranin and cytokeratin was diffusely positive in the tumor cells ( Figure 3).Electron microscopic examination revealed numerous cytoplasmic, membrane-bound electron-dense granules, which were pleomorphic.
DiscussionCarcinoid tumors are the most common tumors of the appendix and small intestine. They arise from the epithelium containing argentaffin or argyrophil cells. Up to...
Idiopathic retroperitoneal fibrosis (IRF) may cause ureteric obstruction with renal damage. Ureterolysis with intraperitonealization of the ureter is commonly used as primary treatment. We gave corticosteroids for two years to six patients, four males and two females, between 40 and 56 years of age. one of the patients is in his tenth month of treatment and another in the fourth month. Between 4 and 74 months (mean 40.4 months) after initiation of treatment, kidney function had improved, or was preserved in previously functioning renal units, and the patients were free from symptoms. We conclude that steroids may be used as primary treatment of IRF after histological or cytological diagnosis to exclude retroperitoneal malignancy. Steroids should also be part of the treatment strategy in patients with a more aggressive disease who may need surgery. Patients with IRF should be followed for the rest of their lives after discontinuation of steroid therapy.
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