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  • ISSN: 2641-7790
    Current Issue
    Volume 1, Issue 1
    Research Article
    Prashant Ramteke, Adarsh Barwad, Immanual Pradeep, Anubhav Narwal, Ravi Phulware Prasenjit Das, Asit Ranjan Mridha, and Seema Kaushal*
    Introduction: Mucinous tubular and spindle cell carcinoma (MTSCC-K) is a rare subtype of renal cell carcinoma in adults. Morphologically, tumor is composed of variable admixture of three main components: tubules, spindle cells and extracellular mucinous/myxoidstroma. Although diagnosis in tumors with classical morphology is straightforward, difficulty arises in MTSCC-K with dominant papillary morphology particularly in mucin poor variants. In current study we reviewed the clinico-pathological and immunohistochemical features of MTSCC-K with emphasis on mucin poor variants.
    Material and methods: Cases of MTSCC-K were selected from archives and detailed clinical features and follow-up was collected. Histopathological findings were noted and immunohistochemistry for CK7, AMACR, CD10, EMA, CD15 and CD117 was performed.
    Results: In our study series of 10 cases, two showed prominent papillary component with presence of focal mucin. Three cases showed mucin poor pattern requiring cytochemical confirmation by Alcian Blue. None of the cases displayed morphological variations like clear cell, oncocytic change, sarcomatoid or neuroendocrine differentiation. All the cases showed variable expression of CK7, AMACR, CD10, EMA, CD15 and CD117.
    Conclusion: The mucin poor variant posed significant diagnostic challenge in differentiating from type I papillary renal cell carcinoma (PRCC). Immunohistochemistry is of limited help in such cases and simple cytochemical staining by Alcain Blue is helpful in demonstrating the mucin. Cytogenetic studies are important in grey-zone cases.
    Aimee Rogers, Adam Luchey, Robert Shapiro, Dale Riggs, Barbara Jackson, Stanley Kandzari, and Stanley Zaslau*
    Introduction: We have previously reported that the addition of pentosan polysulfate (PPS) to a regimen of anti-depressant medication for the treatment of Painful Bladder Syndrome (PBS) failed to improve patient symptom scores, evaluated by the Female Sexual Function Index (FSFI). Herein, we report on 1300 subjects indexed by the use anti-depressant medication and further indexed by both the class of anti-depressant and PPS use. The degree of FSD associated with the disease was then compared.
    Methods: Domain values were obtained using the FSFI. The respondents were indexed first by the use of anti-depressant medication and then by the class of such medication (Tricyclic antidepressants (TCA), Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), Benzodiazepines, and Aminoketones), then further by the use of PPS.
    Results: No differences in overall FSFI was observed among the 5 classes of anti-depressant medication (NS). When the 6 domains of FSFI were examined no differences were observed in Arousal, Lubrication, Orgasm, Satisfaction and Pain. However, respondents taking Aminoketones had a significantly higher FSFI score in the domain of Desire than those taking TCA (p=0.016), SSRIs (p=0.016), SNRIs (p=0.03) and Benzodiazepines (p=0.04). The addition of PPS to the anti-depressant medication produced no patient benefit over that of the anti-depressants alone. The addition of PPS to Benzodiazepines significantly worsened pain from 1.61 + 1.55 to 0.54 + 0.51 (p=0.007)
    Conclusions: The addition of pentosan polysulfate sodium (PPS) to a regimen of anti-depressant medication for the treatment of PBS failed to improve patient symptom scores, as evaluated by the FSFI.
    Morris Jessop, Dale Riggs, Barbara Jackson, and Stanley Zaslau*
    Introduction and objective: Painful Bladder Syndrome (PBS) is a chronic, painful inflammation of the bladder wall. The cause of PBS is still unknown but physiological stress may play a role, and although there are many treatments available to relieve the symptoms there is no cure at this time. The lack of curative treatment modalities is further hampered by the lack of representative in vivo models. In an effort to establish an in vivo model of PBS, the effect of chronic mild stressors on normal mouse bladders was evaluated for the effect on both mast cells and urothelium thickness.
    Methods: Forty male mice were exposed a series of random stressors daily (Cage Tilt, Damp Sawdust, No Sawdust, Social Stress, and Varying Light/Dark Cycles). After 16 weeks the mice were sacrificed and the bladders were prepared for pathologic investigation. The urinary bladders were formalin-fixed, paraffin-embedded, and evaluated using routine light microscopy with hematoxylin and eosin, giemsa, and PAS stained sections. Urothelial and detrussor muscle mast cell numbers were evaluated by averaging ten representative 200x fields in the Giemsa section. Urothelial thickness was evaluated by averaging six representative regions in the PAS section. The control and test groups were statistically compared using the non-parametric Mann-Whitney method.
    Results: Urothelium was found to be significantly decreased in thickness when comparing the test to control mice (p = 0.0041). Additionally, the quantity of urothelial/sub mucosal mast cells was increased in the test versus control mice (p< 0.0001). No significant difference was observed in the quantity of detrusor mast cells.
    Conclusion: The absence of effective and representative models of PBS has severely hindered the pursuit of curative treatments modalities for this disease. The significant reduction in both urothelial mast cells and in the thickness of the urothelium suggest that chronic multiple stressors may be effective in inducing bladder urothelial changes in mice. This data may provide investigators with an effective in vivo mouse model of PBS.
    Commentary
    Alberto Perez-Lanzac*
    The use of smaller incisions, the reduction in the number or the size of trocars seems to be the natural evolution of the incredible revolution in the field of urology thanks to laparoscopic procedures. LESS surgery and NOTEs aim to reduce the impact of surgery through the use of a single incision or through natural orifices to complete the surgery. Both approaches are technically demanding for surgeons. This has resulted in a slow and difficult expansion. In contrast, mini laparoscopy (ML) means a continuation of the principles of conventional laparoscopy, in which ergonomics and triangulation are preserved [1]. The recent advent on the market of a new generation of mini laparoscopy instruments has led to a increase in the use of ML in a great variety of extirpative and reconstructive procedures [2].
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