To investigate the adjunctive role of some peripheral blood parameters to serum prostate specific antigen (PSA) in predicting the patients with prostate cancer (PCa) prior to prostate biopsy, and clinically significant PCa among those. Material and Methods: This prospective study included men aged ≥45 years, who were scheduled to undergo a prostate biopsy due to gray-zone PSA levels. The levels of free and total PSA (fPSA and tPSA), total testosterone (TT), PSA density (PSAD), C-reactive protein (CRP), De Ritis ratio (aspartate aminotransferase/alanine transaminase) and hemograms were recorded. Patients were divided into 2 groups as benign prostatic hyperplasia (Group 1) and PCa (Group 2) groups. The PCa group was further divided into 2 subgroups as clinically significant and clinically insignificant PCa. The pre-biopsy values of the variables were compared between the groups. Results: A total of 210 patients were included in the study (Group 1, n=105; Group 2, n=105). The mean age was 65.1±7.4 years, the mean tPSA level was 6.14±2.05 ng/mL, and the mean TT level was 15.46±5.47 nmol/L. Age, prostate volume, the values of fPSA, PSAD, CRP, and the ratios of fPSA/tPSA, CRP/albumin and De Ritis were statistically different between the groups. In the PCa group, only the tPSA level was significantly different between the subgroups (p=0.005). The area under curve and the cut-off value for tPSA to predict clinically significant PCa were 0.669 and 5.8 ng/mL, respectively. Conclusion: CRP, the CRP/albumin ratio and De Ritis ratio may further help predict a diagnosis of PCa.

ÖZET Güncel taş rehberlerine göre >2 cm böbrek taşlarının tedavi algoritmasında ilk önerilen yöntem perkütan nefrolitotomidir (PNL). Taşsızlık oranı yüksek olan bu yöntemde her cerrahi işlemde olabileceği gibi çeşitli komplikasyonlar görülebilmektedir. Sol böbrek ve dalağın yakın anatomik ilişkisi nedeniyle iyatrojenik dalak yaralanmaları PNL sırasında nadir de olsa meydana gelebilmektedir ve çoğunlukla transspleniktir. PNL'ye bağlı dalak yaralanması, erken tanı gerektiren ve ölümcül seyredebilen bir komplikasyondur. Çok nadir görülen bu durumun tedavi şekli, genellikle konservatif yönetim veya splenektomidir. Bu yazıda, sol böbrek taşı nedeniyle PNL uyguladığımız hastada, giriş kılıf manipülasyonlarına bağlı künt travmaya sekonder geliştiğini düşündüğümüz ve konservatif tedavi ile yönettiğimiz subkapsüler dalak hematomu olgusunu güncel literatür eşliğinde sunmayı amaçladık.Anah tar Ke li me ler: Konservatif tedavi; nefrolitotomi, perkütan; dalak rüptürü ABS TRACT Percutaneous nephrolithotomy (PNL) is the first recommended method in the treatment algorithm of kidney stones >2 cm, according to the current guidelines. In this procedure, which has a high stone-free rate, various complications can be seen as in any surgical treatments. Due to the close proximity of the left kidney and spleen, iatrogenic spleen injuries may occur rarely during PNL surgery and are mostly trans-splenic. Splenic injury due to PNL procedure is a fatal complication that requires early diagnosis. The treatment for this very rare condition is usually conservative management or splenectomy. In this paper, we aimed to present a case of subcapsular splenic hematoma, which we thought developed secondary to blunt trauma due to access sheath manipulations and was managed with conservative treatment, in a patient who underwent PNL due to left kidney stone, in the light of current literature.

Primitive neuroectodermal tumors (PNET) are most common in the central nervous system. Peripheral placements are extremely rare. PNET is from the Ewing sarcoma family. Ewing's sarcoma is evaluated in two groups: bone and non-bone origin. Renal PNET is extremely rare. Peripheral PNETs of renal origin are usually seen in young adults. They progress with an aggressive clinical picture and have a poor prognosis. In the follow-up imaging of a 62-year-old female patient after gastrectomy due to stomach cancer (adenocarcinoma), a renal mass was detected incidentally in the left kidney. The patient had no identified complaints. In the middle segment of the left kidney, computed tomography (CT) examination revealed a 42.5x44.6 mm nodular mass lesion, which was noticed as hypodense with contrast material.The patient underwent laparoscopic left radical nephrectomy. On pathological examination, a diagnosis of PNET/Ewing sarcoma was made. Immunohistochemically, membranous/cytoplasmic and nuclear staining with FLI1 and CD99 were observed in the tumor sections. However, staining with LCA was not seen.The patient was scheduled for chemotherapy by oncology. At the end of the fourth course of chemotherapy, no recurrence was found in the radiological controls of the patient.