ABSTRACTS OF THE 21st ANNUAL MEETING OF THE ITALIAN ...

Abstracts of the 21st Annual Meeting of the Italian Society of Uro-Oncology (SIUrO), 22-24 June, 2011, Naples, Italy
hydrocele. The patient underwent cytoanalysis of the
hydrocele fluid: many mesothelial cells with nuclear and
cytoplasmic atypias were found. Preoperatively, the patient
was studied with whole-body CT. He was treated with left
hemiscrotectomy in January 2009. Grossly, the testicle was
filled with a whitish plurinodular, in places pseudocystic and
gelatinous neoformation, which involved the Tunica
vaginalis, Tunica albuginea and scrotal tissues and reached
the epididymis. Histopathology demonstrated an MM arising
from the Tunica vaginalis, characterized by a epithelioid
pattern and tubulopapillary architecture; focal necrosis and
endovascular invasion were found. Immunochemistry showed
high cytokeratin, epithelial membrane antigen (EMA) and
calretinin positivity. No adjuvant treatment was administered.
Results: The patient lived without evidence of disease until
October 2010, when left-groin adenopathies developed.
Ultrasonography confirmed the presence of four metastastic
nodes, the largest one of 4 cm, and also revealed a suspicious
node in the right groin. A nodal biopsy in the left groin
resulted in the diagnosis of MM metastasis. A subsequent
PET/CT scan demonstrated radioactive tracer fixation in both
groins and in para-aortic nodes. The patient was enrolled in a
chemoradiation therapeutic program. He has just completed
three cycles of pemetrexed-based chemotherapy with passable
results and will undergo radiotherapy to all sites of the
disease. According to the literature, radiotherapy can be even
more effective than chemotherapy in patients with metastatic
disease. Discussion and Conclusion: Our case report
underlines the importance of a correct preoperative diagnosis
and an accurate staging because these tumors often present as
a hydrocele or an epididymal cyst. The diagnosis of MM of
the Tunica vaginalis should be considered in any patient
presenting with a rapidly growing hydrocele. Because most
cases of MM are found intra- or postoperatively, many
patients undergo suboptimal resection and the diagnosis of
malignancy is achieved late. Instead, the only useful treatment
is radical orchiectomy through an inguinal approach or
hemiscrotectomy, in the case of initial involvement of the
scrotum. There is no role for inguinal or iliac lymph-node
dissection when there is no suspicion of metastasis. Our
patient was well-studied preoperatively and underwent
adequate surgery. Unfortunately, in a considerable proportion
of patients, risk of local recurrence is high: nearly 40% of
patients present with negative prognostic factors, such as local
invasion to subtunical connective tissues and testicular
parenchyma, and 12% develop recurrence after surgery. In the
light of literature findings, surveillance after orchiectomy can
be considered a valid policy for many patients. However,
there are some conditions which are predictors of relapse and
should be taken into account when considering the
opportunity for an immediate adjuvant treatment, as our case
report highlights. Moreover chemotherapy and/or
radiotherapy to the sites of relapse can be adopted as salvage
treatment. Finally, this case report emphasizes the importance
of oncologic follow-up after surgery.
1 Ashis G et al: Malignant mesothelioma of the Tunica
vaginalis of the testis without exposure to asbestos. Cases
Journal 1: 310, 2008.
2 Chen JL and Hsu YH: Malignant mesothelioma of the
Tunica vaginalis testis: a case report and literature review.
Kaohsiung J Med Sci 25(2): 77-80, 2009.
3 Liguori G et al: Inguinal recurrence of malignant
mesothelioma of the Tunica vaginalis: one case report with
delayed recurrence and review of the literature. Asian J
Androl 9(6): 859-860, 2007.
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ACTIVE SURVEILLANCE FOR PROSTATE
CANCER: NOMOGRAM PREDICTING
THE RISK OF UPGRADIG/UPSIZING AT
ONE-YEAR REPEAT BIOPSY
Tiziana Rancati1 , Riccardo Valdagni2 , Maurizio Colecchia3 ,
Roberto Salvioni4 , Sergio Villa5 , Nice Bedini5 ,
Davide Biasoni4 , Cristina Marenghi6 , Barbara Avuzzi5 ,
Biagio Paolini3 , Tiziana Magnani1 and Silvia Catania7 1Fisica Medica, 6Oncologia Medica, Direzione Direzione
Scientifica, 2Direttore Programma Prostata, Direttore
Radioterapia Oncologica 1, 3Anatomia Patologica,
4Urologia, 5Radioterapia Oncologica 1,
7Programma Prostata, Fondazione IRCCS,
Istituto Nazionale dei Tumori, Milano, Italy
Background: Since 2005, we have been proposing the use of
active surveillance (AS) for low-risk prostate cancer (PCa).
Variables influencing upgrading/upsizing at the first repeat
biopsy (one year after the beginning of AS) are analyzed here to
identify patients with a higher probability of upgrading/upsizing
after a short time in AS, and a preliminary nomogram is
presented. Patients and Methods: The AS institutional protocol
(SAINT) started in March 2005 and was accepted by 86
patients. Entry criteria were: iPSA≤10 ng/ml, Tstage≤T2a,
GPS≤3+3, positive biopsy cores≤20%, maximum core length
containing cancer ≤50%. Patient drop out was: PSADT≤3 years,
PSA>10 ng/ml, upgrading/upsizing at re-biopsy or personal
choice. In November 2007, the PRIAS protocol was embraced:
126 patients were enrolled until October 2010. PRIAS vs.
SAINT differs on: maximum 2 positive cores and PSA
density