We report a case of pelvic lipomatosis with ureteral obstruction and vesicoureteral reflux. In addition to computerized tomography, nuclear magnetic resonance imaging provided definite and graphic proof of the diagnosis. Operative treatment consisted of ureteroileocystostomy.
Objective To evaluate variables for the prediction of node metastases were present in two of eight patients without clinically palpable inguinal nodes, in three of lymph node metastases in carcinoma of the penis, using a recently proposed modified tumour-staging 14 with nodes clinically thought to be infective and in 11 of 12 nodes clinically considered to be malignant. system that combines the histological degree of diÂer-entiation and extent of local invasion of the primary Lymph node metastases were present in five of 17 patients with grade 1, in nine of 13 with grade 2 and tumour.Patients and methods Thirty-five patients with squamin three of five with grade 3 tumours. Using the modified histological T-staging system (T1=grade ous carcinoma of the penis and histo-or cytological staging of the inguinal lymph nodes were reviewed.1-2, invasive through dermis; T2=any grade, invasion of corpus spongiosum or cavernosum; A clinical TNM staging system was used in which the size (diameter) of the primary tumour and the clinical T3=any grade, invasion of urethra; T4=grade 3, regardless of invasion) lymph node metastases were extent of invasion were considered. Subsequently, the tumours were also staged according to a modified present in one of nine patients with T1, in eight of 16 with T2, in all five with T3 and in three of five with T-system in which the histological degree of diÂeren-tiation and pathological extent of tumour invasion T4 tumours. Conclusion The modified T-staging system, which comwere combined.Results Penectomy was performed in 34 patients (partial bines histological diÂerentiation with pathological extent of invasion, provided the best predictive distincamputation in 20 and radical penectomy in 17).Inguinal lymphadenectomy was performed in 31 tion between T1 and T2-4 tumours, indicating that lymphadenectomy can be avoided in T1 tumours, but patients and in four the presence of lymph node metastases was confirmed by aspiration cytology.should be performed in all patients with T2-4 tumours. We recommend bilateral inguinal lymphadUsing the clinical TNM staging system, lymph node metastases were histo-or cytologically present in no enectomy 6-8 weeks after penectomy in such patients.
Case ReportA.S. was referred to this department in September 1988 with metastatic prostate carcinoma. Two years previously he had presented elsewhere with abdominal pain and weight loss. Cervical lymphadenopathy was noted and biopsy revealed poorly differentiated adenocarcinoma in the lymph nodes. Computed tomography at that time revealed retroperitoneal lymphadenopathy and the patient received chemotherapy. Three months later sclerotic bone metastases were noted, a diagnosis of prostatic carcinoma was made and the patient was treated with stilboestrol with a good response. In May 1988 he was seen by the Radiotherapy Department at this hospital with severe bone pain and was treated by half-body irradiation, again with a reasonable response. At this stage he stopped using stilboestrol. When seen by us he complained of weight loss, pain, enlarged lymph nodes and painful enlarged breasts. On examination he was cachexic and cervical and axillary lymphadenopathy was noted. There was also marked bilateral gynaecomastia which was stony hard in consistency. Rectal examination revealed a small clinically benign prostate. Total acid phosphatase was raised at 324.2 u/l (normal range 4.8-13.5) with a prostatic fraction of 272.7 u/l (normal < 3.7).Alkaline phosphatase was 235 u/l (normal range 30-85) and lactate dehydrogenase 662 u/l (normal range 100-350).
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