Vikram J Anand

• Consultant surgeon
• Kalra Hospital and Sri Ram Cardio-Thoracic
• & Neurosciences Centre,
• New Delhi, India
• Supervisor for postgraduate surgical studies
• The National Board of Examinations,
• New Delhi, India
• Surgical tutor and examiner
• The Royal College of Surgeons of Edinburgh,
• Scotland, UK
• Professor of surgery and former director,
• department of surgery
• Maulana Azad Medical College and
• Associated Hospitals, New Delhi, India

The epididymis is replaced by a small mass of cellular connective tissue with abundant blood vessels at the blind end of the vas deferens symptoms after embryo transfer 1 mg finax buy visa. Absence of the corpus of the epididymis gives rise to a characteristic malformation called bilobed epididymis medicine xifaxan purchase finax 1 mg amex. This Congenital Anomalies of the Male Mesonephric Ducts varies from simple strangulation to complete separation of the caput and cauda treatment xdr tb discount 1 mg finax fast delivery. Testis-epididymis dissociation is found in 1% of cases of obstructive azoospermia and is usually associated with cryptorchidism medications 101 order generic finax from india. Defects in connection of the ductuli efferentes and ductus epididymidis are rarely complete symptoms whiplash purchase cheap finax. In the incomplete form, some of the 5 to 30 ductuli efferentes in the epididymis are short and end blindly. Epididymal cyst usually arises from blind-ending ductuli efferentes and contains spermatozoa. Some epididymal cysts arise from embryonic remnants, do not contain spermatozoa, and are lined by columnar or pseudostratified epithelium. The most common malformations are elongate epididymis, angulated epididymis, and free epididymis. The length of the epididymis may be several times that of the testis, and in abdominal or inguinal cryptorchidism the epididymis extends several centimeters below the testis. Angulated epididymis is characterized by long epididymis that has a sharp bend in the corpus, with or without stenosis. The most frequent anomalies of the vas deferens are congenital absence, segmental aplasia, ectopia, duplication, diverticula, and crossed dystopia. Absence of the vas deferens may be associated with other malformations of the sperm excretory ducts or the urinary system. The most frequent malformations of the excretory ducts are absence of the ejaculatory ducts (33% of cases) and, less frequently, absence of the seminal vesicles. Approximately 71% of patients with bilateral absence of the vas deferens have partial aplasia of the epididymis. The most frequent malformations of the urinary system are absence of the ipsilateral kidney and other renal anomalies. Persistent mesonephric duct consists of the ureter joined to the vas deferens, forming a single duct that opens into an ectopic orifice between the trigone and verumontanum. This malformation may be associated with cystic transformation or absence of the seminal vesicle. The most frequent anomalies are agenesis of the seminal vesicles or ejaculatory ducts, cyst of the seminal vesicle, and ectopic opening of the ureter into the seminal vesicle. The last anomaly is the most common and often is associated with ipsilateral renal dysplasia. Epididymitis is a frequent cause; Chlamydia trachomatis and Escherichia coli are currently the most common infectious causes. Testicular and Epididymal Lesions Resulting From Obstruction of Sperm Excretory Ducts. Obstruction at the level of the ampulla of the vas deferens, seminal vesicles, or ejaculatory ducts does not usually cause significant lesions in the testis or epididymis. More proximal obstruction at the level of the vas deferens, epididymis, or testis-epididymis junction usually causes severe lesions in both the sperm excretory ducts and the testicular parenchyma. Obstruction of the vas deferens causes increased pressure within the ductus epididymis. The ductuli efferentes often become cystically dilated and filled with spermatozoa and macrophages. The caput epididymidis shows a marked dilation of the ductuli efferentes that contain numerous spermatozoa. Abundant spermatozoa in the intertubular interstitium of the epididymis both free and inside the cytoplasm of macrophages. The lesion is located in the wall of a dilated efferent duct with abundant spermatozoa. Macrophages and lymphocytes often are present in the intertubular connective tissue. Congenital ejaculatory duct obstruction and congenital absence of the vas deferens usually causes minimal testicular injury, mainly dilation of the seminiferous tubules, and an increase in number of mature (Sc + Sd) spermatids. Increased intraluminal pressure in the epididymis may give rise to pain (late postvasectomy syndrome). Lesions may be significant if the epididymis is damaged by hydrocelectomy, consisting mainly of primary spermatocyte sloughing. Hyalinized tubules may also be present when obstruction is caused by inflammation. Obstruction in the caput of the epididymis causes disappearance of all germ cells in the adluminal compartment of seminiferous tubules. Testicular alterations after vasectomy may not be related to the duration of the obstruction, but rather to the initial injury, and may disappear with time as the intraluminal pressure decreases. Vasal patency is restored in most cases of reanastomosis, but paternity rates are markedly lower (25% to 51%) than normal (85%). At first, spermatozoa obtained from the testis are of better quality than those from the epididymis. These findings are characteristic of two main conditions: Young syndrome and alterations in spermatozoal transport. Young syndrome is defined by the following constellation of findings: azoospermia, sinusitis, bronchitis or bronchiectasis, and normal spermatozoal flagella. Patients have a lesion at the junction of the caput and corpus that gives the epididymis a characteristic gross appearance of distension, with the ductuli efferentes containing yellow fluid and numerous spermatozoa, whereas the remaining epididymal segments are normal. Ciliary dyskinesia consists of morphologic, biochemical, and functional alterations in cilia and flagella, including immotile cilia syndrome, Kartagener syndrome, and miscellaneous syndromes characterized by imperfectly defined abnormalities of cilia and flagella. Normally, spermatozoa detach from Sertoli cells and traverse the intratesticular and extratesticular excretory ducts, where they are stored, mainly in the cauda of the epididymis, and ultimately released from the corpus by ejaculation or eliminated by phagocytosis. Whereas the release of spermatozoa from the corpus is intermittent, transit through the sperm excretory ducts is continuous. Spermatozoa are propelled along the length of the epididymis in a mean of 12 days (range, 1 to 21 days). The walls of the seminiferous tubules and extratesticular excretory ducts are under hormonal and neural control. The myofibroblasts in the seminiferous tubules have oxytocinic, 1-adrenergic, -adrenergic, and muscarinic receptors. Unmyelinated nerve fibers penetrate the tubular lamina propria, pass among the myofibroblasts, and end near the Sertoli cells. The ductus epididymidis is innervated by sympathetic adrenergic nerve fibers that end among smooth muscle cells. Several hormones, including oxytocin, endothelin-1, vasopressin, and prostaglandins, act on the musculature of the ductus epididymidis. The frequency and amplitude of contractions vary from region to region; they are higher in frequency near the caput and of maximal amplitude in the initial portion of the cauda. The progressive increase in amplitude parallels the progressive increase in the thickness of the muscular wall and the requirement for greater force to propel the fluid as it becomes progressively more viscous with a higher concentration of spermatozoa. The distal portion of the cauda is usually at rest because it is the main reservoir of spermatozoa between ejaculations. Several times daily, vigorous contractions of the distal cauda impel the spermatozoa from the cauda toward the vas deferens. When findings associated with a poor prognosis are present, patients may require assisted reproductive techniques. The frequency of chromosomal abnormalities increases in an inverse relationship with the number of spermatozoa in the ejaculate. Lesions in the adluminal compartment: most are obstructive (exception: absence or markedly decreased Sa + Sb with normal or increased spermatocytes I). Anomalies in spermatids: high number of multinucleate, macrocephalic, round, without acrosome, or short- and thick-flagellum spermatids. Testicular pathology secondary to alteration in hypothalamopituitary-testicular axis and other endocrine disorders. Some lesions in the adluminal compartment (sharp interruption in spermatocytes I or round spermatid maturation). Anomalies in spermatogonia: high number of hypertrophic, multinucleate, and dislocated spermatogonia. Adluminal and basal compartment lesions with disproportionate sloughing of spermatocytes or round spermatids. The original description was of a man with eunuchoidism, gynecomastia, small testes, mental retardation, and elevated levels of serum gonadotropins. Lesions involve seminiferous tubules and interstitium: (1) tubular atrophy may lead, through a hyalinization process, to complete disappearance of tubules, with only ghost tubules remaining; and (2) there is an apparent increase in the number of Leydig cells, which form characteristic nodules that tend to coalesce and delete the testicular structure. Even though the estimated incidence of this disorder is 1 in 600 male newborns, and many children with Klinefelter syndrome present with language and behavior problems, as well as mental retardation, only a few patients (10%) are diagnosed before puberty. Study of Klinefelter syndrome currently involves a search for X-chromosome genes involved in triggering and development of testicular lesions. Mosaicisms are caused by mitotic nondisjunction in the zygote after fertilization. The diagnosis of Klinefelter syndrome in infants, who may have few clinical stigmata of the disorder, calls for other techniques besides microscopic analysis of G-banded chromosomes. Although this technique is the gold standard, it is time consuming, requires experience, and is expensive. Somatic cells express gene products only when they have more than one X chromosome. Only 25% are recognized in the pediatric age group, principally during adolescence. This is variable and ranges from normal development to the absence of secondary sex characteristics. These patients have been described as immature, lacking in initiative, and emotionally unstable, with poor concentration capacity. A better knowledge of Sertoli and Leydig cell physiology has led investigators to establish a strong correlation between hormonal changes and lesions. In mosaicism the Sertoli cell­only tubules may be more numerous than hyalinized tubules. Most seminiferous tubules, even those with Sertoli cell only, have scant elastic fibers that may be demonstrated with orcein stain. The intense staining observed in the inner elastic lamina of arterioles provides a positive control. Peritubular cells have impaired myoid differentiation and are unable to produce elastic fibers. It is likely that an abnormal proportion of some genes in the X chromosome changes germ cell division or apoptotic rate. Focal spermatogenesis, as occurs in some patients, may originate in euploid germ cells. This 21 disomy may be an important risk factor for gonosomy, as well as for trisomy 21. Immature fibroblast-like Leydig cells may be present, and cells with hypertrophic cytoplasm and those with signs of exhaustion may also be observed. Leydig cell function is insufficient, and androgen levels are less than 50% of normal. They have eunuchoid habitus with long legs, small penis and testicles, gynecomastia, and hypergonadotropic hypogonadism. In the mediastinum, possible origin from primordial thymus cells has been postulated. Seminiferous tubules showing decreased diameters, isolated germ cells, and a ring-shaped tubule that contains a microlith. Leydig cell tumor, and epidermoid cyst) is comparable with that of the general population. Early identification of Klinefelter syndrome is possible through systematic cytogenetic study of newborns with positive sex chromatin or mental retardation. Germ cell number in genital ridges does not differ from normal, but early cell loss takes place once testis differentiation begins. Germ cell loss is associated with irregular distribution of germ cells: tubules with germ cells alternate with vacant tubules. In some cases of Klinefelter syndrome associated with Down syndrome, tubular hyalinization is observed in childhood. If one testis is undescended, its histologic features do not differ from those of the contralateral testis. On the contrary, germ cells decrease in number (or even totally disappear) from the second year of life onward in cases with associated cryptorchidism despite the presence of testosterone. When a new wave of germ cell proliferation would be expected, if it actually takes place, it occurs only in some tubules, where a few spermatocytes may be observed; otherwise germ cells completely disappear. Precocious puberty refers to development of secondary sex characteristics in a boy before the age of 9 years. Karyotyping in older boys with mental retardation, gynecomastia, small testes, and precocious puberty is advisable. Klinefelter syndrome is often associated with pituitary disorders such as panhypopituitarism or incomplete hypopituitarism. However, these men exhibit normal body proportions, normal or slightly short stature, and normal intelligence, in contrast with men with Klinefelter syndrome.

Ossified cystic metastasis of bladder tumor to abdominal wound after partial cystectomy medications for depression order finax 1 mg online. Tumour infiltrating lymphocytes as an independent prognostic factor in transitional cell bladder cancer treatments for depression order finax with a visa. Tumor-associated tissue inflammatory reaction and eosinophilia in primary superficial bladder cancer medicine hat weather buy finax 1 mg. Intense inflammation in bladder carcinoma is associated with angiogenesis and indicates good prognosis medicine app 1 mg finax order. Urothelial carcinoma following augmentation cystoplasty: an aggressive variant with distinct clinicopathological characteristics and molecular genetic alterations medicine 0829085 finax 1 mg line. Clinicopathologic characterization of intradiverticular carcinoma of urinary bladder-a study of 22 cases from a single cancer center. Updated protocol for the examination of specimens from patients with carcinoma of the urinary bladder, ureter, and renal pelvis. Classification and grading of noninvasive and invasive neoplasms of the urothelium. A contemporary update on pathology standards for bladder cancer: transurethral resection and radical cystectomy specimens. The importance of transurethral resection in managing patients with urothelial cancer in the bladder: proposal for a transurethral resection of bladder tumor checklist. Prognostic factors in stage T1 bladder cancer: tumor pattern (solid or papillary) and vascular invasion more important than depth of invasion. Lymphovascular invasion in transurethral resection specimens as predictor of progression and metastasis in patients with newly diagnosed T1 bladder urothelial cancer. Prognostic significance of vascular and perineural invasion in urothelial bladder cancer treated with radical cystectomy. Lymphovascular invasion is independently associated with overall survival, cause-specific survival, and local and distant recurrence in patients with negative lymph nodes at radical cystectomy. Prognostic significance of lymphovascular invasion of bladder cancer treated with radical cystectomy. Lymphovascular invasion is independently associated with poor prognosis in patients with localized upper urinary tract urothelial carcinoma treated surgically. Clinicopathological significance of lymphovascular invasion in urothelial carcinoma. Lymphovascular invasion of urothelial cancer in matched transurethral bladder tumor resection and radical cystectomy specimens. Prognostic value of perinodal lymphovascular invasion following radical cystectomy for 506. Characteristics and outcomes of patients with clinical carcinoma in situ only treated with radical cystectomy: an international study of 243 patients. Lymphovascular invasion is independently associated with bladder cancer recurrence and survival in patients with final stage T1 disease and negative lymph nodes after radical cystectomy. Villous adenoma of the urinary tract: a report of 23 cases, including 8 with coexistent adenocarcinoma. Villous adenoma of the urinary tract: a lesion frequently associated with malignancy. Mullerian adenosarcoma of the urinary bladder: clinicopathologic and immunohistochemical features with novel genetic aberrations. Glandular lesions of the urinary bladder: clinical significance and differential diagnosis. Histogenesis of clear cell adenocarcinoma in the urinary tract: evidence of urothelial origin. Telomere shortening and chromosomal abnormalities in intestinal metaplasia of the urinary bladder. 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P53 expression in small cell carcinoma of the urinary bladder: biological and prognostic implications. Report of five cases with immunohistochemistry and review of the literature with evaluation of prognosis according to stage. Successful treatment with combined radical cystoprostatectomy and adjuvant methotrexate, vinblastine, doxorubicin, and cisplatin chemotherapy. Chromosome abnormalities and p53 expression in a small cell carcinoma of the bladder. Expression of the tyrosine kinase c-kit is an independent prognostic factor in patients with small cell lung cancer. Detection of overexpressed and phosphorylated wild-type kit receptor in surgical specimens of small cell lung cancer. Thyroid transcription factor 1 expression in small cell carcinoma of the urinary bladder: an immunohistochemical profile of 44 cases. Large cell and small cell neuroendocrine bladder carcinoma: immunohistochemical and outcome study in a single institution. Morphology and therapeutic strategies for neuroendocrine tumors of the genitourinary tract. Value of thyroid transcription factor-1 immunostaining in distinguishing small cell lung carcinomas from other small cell carcinomas. Large cell neuroendocrine carcinoma of the urinary bladder with lymphoepithelioma-like features. Primary carcinoid tumors of the urinary bladder and prostatic urethra: a clinicopathologic study of 6 cases. Proceedings: A case of malignant pheochromocytoma producing parathyroid hormone-like substance. Malignant pheochromocytoma of the bladder: the late development of renal cell carcinoma. Malignant paraganglioma (pheochromocytoma) of the urinary bladder: report of a case and review of the literature. Paraganglioma of the urinary bladder: a lesion that may be misdiagnosed as urothelial carcinoma in transurethral resection specimens. An immunohistochemical study of human postnatal paraganglia associated with the urinary bladder. Pigmented extraadrenal paraganlioma: a clinicopathologic and immunohistochemical study of five cases. Primary primitive neuroectodermal tumour of the urinary bladder: a clinico-pathological study emphasising immunohistochemical, ultrastructural and molecular analyses. Malignant peripheral nerve sheath tumor (malignant schwannoma) of urinary bladder in von Recklinghausen neurofibromatosis. Epithelioid variant of malignant peripheral nerve sheath tumor (malignant schwannoma) of the urinary bladder. Malignant "triton" tumors: a clinicopathologic and immunohistochemical study of nine cases. Sarcomatoid transitional cell carcinoma vs pseudosarcomatous stromal reaction in bladder carcinoma: an immunohistolchemical study. Sarcomatoid carcinoma of the urinary bladder: a clinicopathologic and immunohistochemical analysis of 14 patients. Clinicopathologic analysis of 18 cases with immunohistochemical and electron microscopic findings. Analysis by comparative genomic hybridization of epithelial and spindle cell components in sarcomatoid carcinoma and carcinosarcoma: histogenetic aspects. Sarcomatoid urothelial carcinoma of the bladder: analysis of 28 cases with emphasis on clinicopathologic features and markers of epithelialto-mesenchymal transition. Nonneoplastic and neoplastic spindle cell proliferations and mixed tumors of the urinary bladder. Myxoid and sclerosing sarcomatoid transitional cell carcinoma of the urinary bladder: a clinicopathologic and immunohistochemical study of 25 cases. Primary heterologous carcinosarcoma (metaplastic carcinoma) of the urinary bladder: a clinicopathologic, immunohistochemical, and ultrastructural analysis of eight cases and a review of the literature. Soft tissue tumors of the urinary bladder, part I: myofibroblastic proliferationas, benign neoplasms, and tumors of uncertain malignant potential. Pseudosarcomatous myofibroblastic tumor of the urinary bladder in children: a study of 11 cases with review of the literature. Pseudosarcomatous myofibroblastic proliferations in the urinary bladder of children. Inflammatory myofibroblastic tumors of the kidney: a clinicopathologic and immunohistochemical study of 12 cases. An approach to the classification of spindle cell proliferations in the urinary bladder. Pseudosarcomatous myofibroblastic proliferation of the bladder: report of 2 cases and literature review. Inflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms. Inflammatory myofibroblastic tumor: the continued definition of one type of so-called inflammatory pseudotumor. Inflammatory myofibroblastic tumour of the urinary bladder mimicking recurrent uterine carcinosarcoma. 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The positive predictive value of "suspicious for high-grade urothelial carcinoma" 23 treatment plan goals generic 1 mg finax otc. Adequacy in voided urine cytology specimens: the role of volume and a repeat void upon predictive values for high-grade urothelial carcinoma treatment of lyme disease buy discount finax on-line. Review of the state of the art and recommendations of the Papanicolaou Society of Cytopathology for urinary cytology procedures and reporting: the Papanicolaou Society of Cytopathology Practice Guidelines Task Force symptoms 6 months pregnant order generic finax online. Voided urine versus bladder washing cytology for detection of urothelial carcinoma: which is better The cytomorphological features of low-grade urothelial neoplasms vary by specimen type symptoms urinary tract infection generic finax 1 mg visa. A modified direct-smear processing technique employing two-step centrifugation/fixation is useful for detecting high-grade urothelial carcinoma treatment jaundice order 1 mg finax amex. Urine cytology of nonurothelial malignancies: a 10-year experience in a large multihospital healthcare system. A comparison between thinprep monolayer and cytospin cytology for the detection of bladder cancer. Diagnostic value of liquidbased cytology in urothelial carcinoma diagnosis: a systematic review and meta-analysis. Comparison between cytospin and liquid-based cytology in urine specimens classified according to the Paris System for Reporting Urinary Cytology. Comparison of the conventional centrifuged and filtrated preparations in urine cytology. Increased risk of malignancy for non-atypical urothelial cell groups compared to negative cytology in voided urine. Improved risk stratification for patients with high-grade urothelial carcinoma following application of the Paris System for Reporting Urinary Cytology. Accuracy and reproducibility of nuclear/cytoplasmic ratio assessments in urinary cytology specimens. Impact of implementing the Paris System for reporting urine cytology in the performance of urine cytology: a correlative study of 124 cases. Does subdivision of the "atypical" urine cytology increase predictive accuracy for urothelial carcinoma Modification of the Paris System for urinary tract washing specimens using diagnostic cytological features. Image cytometric deoxyribonucleic acid analysis of urine specimens as an adjunct to visual cytology in the detection of urothelial cell carcinoma. Urine cytology and urine flow cytometry in renal transplantation-a prospective double blind study. Usefulness of quantifying leukocytes in first-voided urine to predict positivity for Chlamydia trachomatis in asymptomatic men at high risk for chlamydial infection. Significance of pigmented urothelial and non-urothelial cells in voided urine specimens: A case report and review. Histochemical properties of renal leadinclusions and their demonstration in urinary sediment. Cytodiagnostic urinalysis is very useful in the differential diagnosis of acute renal failure and can predict the severity. Melamed-Wolinska bodies in urine cytology an interesting aggregate in a degenerated urothelial cell. Evaluation of eosinophiluria in the diagnosis of schistosomiasis hematobium: a field-based study. Cytological, histological, and clinical correlations in intravesical Bacillus CalmetteGuerin immunotherapy. Positive urinary cytology following a complete response to intravesical bacillus Calmette-Guerin therapy: pattern of recurrence. Correlation between the presence of degenerated inclusion-bearing cells in voided urine samples and the occurrence of polyomavirus infection. Cytomorphological effects of mitomycin C on urothelial cells: eosinophils may be clue to the druginduced changes. Cytological study of the effect of cyclophosphamide on the epithelium of the urinary bladder in man. Electromagnetic and electrohydraulic shock wave lithotripsy-induced urothelial damage: is there a difference Cytological evaluation of urothelial damage in extracorporeal shock-wave lithotripsy. Cytology of lleal conduit urine in bladder cancer patients: diagnostic utility and pitfalls. Decoy cells in the urine cytology of a renal transplant recipient: an immunohistochemical study. A renal variant of Fabry disease diagnosed by the presence of urinary mulberry cells. Urine cytology findings of primary paraganglioma of the urinary bladder: case report. Accuracy and risk of malignancy for diagnostic categories in urine cytology at a large tertiary institution. The Johns Hopkins Hospital template for urologic cytology samples: part I-creating the template. Diagnostic tests and algorithms used in the investigation of haematuria: systematic reviews and economic evaluation. Differences between local and review urinary cytology in diagnosis of bladder cancer. Diagnostic significance of atypical category in the voided urine samples: a retrospective study in a tertiary care center. Clinical value of dividing false positive urine cytology findings into three categories: atypical, indeterminate, and suspicious of malignancy. Applying the Paris System for reporting urine cytology increases the rate of atypical urothelial cells in benign cases: a need for patient management recommendations. The value of the "suspicious for urothelial carcinoma" cytology category: a correlative study of 4 years including 337 patients. A comparison of cytologic, architectural and morphometric criteria in cystoscopically obtained urine. Accuracy of urinary cytology in the diagnosis of primary and recurrent bladder cancer. Diagnostic value of bladder wash cytology, with special reference to low grade urothelial neoplasms. Cytologic diagnosis by key features as identified by logistic regression analysis. Low-grade transitional cell carcinoma of the urinary bladder: application of select cytologic criteria to improve diagnostic accuracy [corrected]. Cytopathologic differential diagnosis of low-grade urothelial carcinoma and reactive urothelial proliferation in bladder washings: a logistic regression analysis. Accuracy and interobserver variability of the cytologic diagnosis of low-grade urothelial carcinoma in instrumented urinary tract cytology specimens. Cytology, flow cytometry, image analysis, and interphase cytogenetics by fluorescence in situ hybridization in the diagnosis of transitional cell carcinoma in bladder washes: a comparative study. A comparison of cytology and fluorescence in situ hybridization for the detection of urothelial carcinoma. Multitarget fluorescence in situ hybridization assay detects transitional cell carcinoma in the majority of patients with bladder cancer and atypical or negative urine cytology. Performance characteristics of a new monoclonal antibody test for bladder cancer: ImmunoCyt trade mark. ImmunoCyt a useful method in the followup protocol for patients with urinary bladder carcinoma. Conventional bladder wash cytology performed by four experts versus quantitative image analysis. The effects of the current World Health Organization/International Society of Urologic Pathologists bladder neoplasm classification system on urine cytology results. The value of exfoliative urine cytology in combination with flexible cystoscopy in the diagnosis of recurrent transitional cell carcinoma of the urinary bladder. External quality assurance in nongynecologic cytology: the Australasian experience. Significance of positive urine cytology on progression and cancer-specific mortality of non­muscle-invasive bladder cancer. Calmette-Guerin treatment for high-risk superficial transitional cell cancer of the bladder Diagnostic ureteroscopy for cases clinically suspected of carcinoma in situ of the upper urinary tract. Investigating upper urinary tract urothelial carcinomas: a singlecentre 10-year experience. The predictive value of positive urine cytology for outcomes following radical nephroureterectomy in patients with primary upper tract urothelial carcinoma: a multi-institutional study. Positive voided urine cytology predicts worse pathological findings of nephroureterectomy specimens in patients with upper tract urothelial carcinoma: does selective ureteral cytology have an additional efficacy Upper tract urothelial carcinomas in patients with chronic kidney disease: relationship with diagnostic challenge. Carcinoid tumor of the renal pelvis: report of a case with positive urine cytology. Atypical cells in a voided urine cytology specimen in a renal transplant recipient. Primary melanoma of the urinary bladder identified by urine cytology: a rare case report. Atypical squamous cells in the urine revealing endometrioid adenocarcinoma of the endometrium with squamous cell differentiation: a case report. Characterization of squamous cell bladder tumors by flow cytometric deoxyribonucleic acid analysis: a report of 100 cases. Cytopathological features of villous adenoma of the urinary bladder in urine: a rare case report. Small cell carcinoma of the urinary bladder and prostate: cytological analyses of four cases with emphasis on the usefulness of cytological examination. Small cell cancer of the genitourinary tract: a case report and review of the literature. Cytomorphologic and immunophenotypic profile of a cohort of small cell carcinoma of the urinary bladder. Signet ring cell carcinoma in urine cytology: cytomorphologic findings and differential diagnosis. Urinary cytodiagnosis: can it have a different prognostic implication than a diagnostic test Urine cytological findings of plasmacytoid urothelial carcinoma of urinary bladder: report of two cases. Urothelial carcinoma with oncocytic features: an extremely rare case presenting a diagnostic challenge in urine cytology. Micropapillary carcinoma of the urinary tract: a cytologic study of urine and fine-needle aspirate samples. Metastatic plasmacytoid urothelial carcinoma: a case report and review of the literature. Performance characteristics of urinary tract cytology: observations from the college of American pathologists interlaboratory comparison program in nongynecologic cytopathology. Clinical value of digital image analysis in the diagnosis of urinary bladder cancer, particularly in aggressive tumors: a preliminary report. Ancillary techniques in the followup of transitional cell carcinoma: a comparison of cytology, histology and deoxyribonucleic acid image analysis cytometry in 91 patients. Artificial neural network in diagnosis of urothelial cell carcinoma in urine cytology. High apoptotic index in urine cytology is associated with high-grade urothelial carcinoma. An ancillary method in urine cytology: nucleolar/nuclear volume ratio for discrimination between benign and malignant urothelial cells. A novel urine-based assay for bladder cancer diagnosis: multi-institutional validation study. Usefulness of immunological detection of the human telomerase reverse transcriptase. Cytokeratin 20 immunocytochemistry on urine sediments: a potential low-cost adjunct to cytology in the diagnosis of low-grade urothelial carcinoma. The diagnostic value of cytohistological urine analysis and cytokeratin 20 in malignant and atypical urothelial cells. Use of vimentin immunocytochemical staining for evaluation of atypical cells in voided urine samples. Prospective analysis of sensitivity and specificity of urinary cytology and other urinary biomarkers for bladder cancer. ImmunoCyt test compared to cytology in the diagnosis of bladder cancer: a meta-analysis. Comparative evaluation of ProEx C and ImmunoCyt/uCyt assays in atypical urine cytology. Comparative study of ProEx C immunocytochemistry and UroVysion fluorescent in-situ hybridization assays on urine cytology specimens. Ubiquilin2 as a novel marker for detection of urothelial carcinoma cells in urine. Immunocytochemical staining for p53 and Ki-67 helps to characterise urothelial cells in urine cytology. Epidermal growth factor receptor and Ki67 as predictive biomarkers identify patients who will be more sensitive to intravesical instillations for the prevention of bladder cancer recurrence after radical nephroureterectomy.

The prognosis of clear cell carcinoma of the urethra is uncertain because of the rarity of this tumor and limited follow-up in reported series medicine 2016 effective 1 mg finax. Clinical management has varied medicine qd order finax with amex, including transurethral resection medications 24 finax 1 mg buy overnight delivery, radical excision medicine park oklahoma finax 1 mg buy mastercard, and radiation therapy medications recalled by the fda discount finax 1 mg with mastercard, or a combination of these. Their morphologic features are similar to their counterparts arising at other sites. Endoscopic examination reveals a nodular mucosal mass or masses that are usually pigmented and frequently ulcerated. Extensive radial growth is common, accounting for the frequency of local recurrence. Metastasis is usually to inguinal and pelvic lymph nodes and common in advanced lesions. Treatment is surgical and includes urethrectomy or penectomy with regional lymph node dissection. Prognosis depends on the thickness of the lesion, similar to melanoma at other mucosal sites. Pathologists should carefully evaluate the status of the mucosal margin of resection because local recurrence at the surgical bed is common. Skip lesions involving the urinary bladder and ureter may occur and should be investigated before extirpative surgery. Soft Tissue Tumors Leiomyoma is the most common soft tissue tumor of the urethra, although fewer than 30 cases have been reported. Urethral leiomyoma ranges in size from 1 to 40 cm and may present as an asymptomatic mass or with dysuria and urinary obstruction. Other nonepithelial neoplasms are rare in the urethra and periurethral soft tissues. These include hemangioma, papillary endothelial hyperplasia, paraganglioma, plasmacytoma, and Malignant Melanoma Although rare, the urethra is the most common site of origin of malignant melanoma in the urinary tract. Steeper and Rosai described a soft tissue tumor arising in the pelvis and perineal soft tissues of women, aggressive angiomyxoma, consisting of vascular fibromyxoid tissue that is locally infiltrative with a tendency to multiple recurrences. Early prenatal diagnosis of concordant posterior urethral valves in male monochorionic twins. Urethral diverticular carcinoma: an overview of current trends in diagnosis and management. Case of duplication of the urethra in an adult male, presenting with symptoms of bladder outlet obstruction. Case of duplication of the urethra in an adult male, presenting with symptoms of bladder outlet obstruction: part 2. Management of urinary tract infections: historical perspective and current strategies: part 1-before antibiotics. Papillary pseudotumor of the prostatic urethra: proliferative papillary urethritis. Derivation of nephrogenic adenomas from renal tubular cells in kidney-transplant recipients. Nephrogenic adenoma of the prostatic urethra: a mimicker of prostate adenocarcinoma. Malacoplakia: a study of the literature and current concepts of pathogenesis, diagnosis and treatment. Urethral stricture associated with malacoplakia: a case report and review of the literature. Human papillomavirus detection in urine samples from male patients by the polymerase chain reaction. Identification of human papillomavirus types in male urethral condylomata acuminata by in situ hybridization. Oncogenic human papillomavirus type-16 is associated with squamous-cell cancer of the male urethra. Human papillomavirus type 6 in grade I transitional cell carcinoma of the urethra. Penile, urethral, and seminal sampling for diagnosis of human papillomavirus infection in men. Papillomas of prostatic urethra with prostatic-type epithelium: report of eight cases. Prostatic urethral polyps in adults: histopathologic variations and clinical manifestations. Transitional cell papilloma of the penis associated with human papilloma virus infection. Inverted papilloma of the urinary tract: histogenesis, recurrence and associated malignancy. Urethrectomy following cystectomy for bladder cancer in men: practice patterns and impact on survival. Transitional cell carcinoma of the urethra in men following cystectomy for bladder cancer: multivariate analysis for risk factors. Carcinoma in situ of the urethra associated with bladder carcinoma: the role of urethrectomy. Prostatic involvement by transitional cell carcinoma: pathogenesis, patterns and prognosis. Transitional cell carcinoma of the urethra in men and women associated with bladder cancer. Detection of carcinoma in the post-cystectomy urethral remnant by flow cytometric analysis. Risk assessment of prostatic pathology in patients undergoing radical cystoprostatectomy. Pseudosarcomatous stromal reaction in primary and metastatic urothelial carcinoma. Epithelial abnormalities and precancerous lesions of anterior urethra in patients with penile carcinoma: a report of 89 cases. Pagetoid carcinomatous involvement of the penile urethra in association with high-grade transitional cell carcinoma of the urinary bladder. Female urethral carcinoma: an analysis of treatment outcome and a plea for a standardized management strategy. Primary urethral carcinoma in females: an epidemiologic study on demographical factors, histological types, tumour stage and survival. Urothelial carcinoma with prominent squamous differentiation in the setting of neurogenic bladder: role of human papillomavirus infection. Carcinoma of the uterine cervix involving the genitourinary tract: a potential diagnostic dilemma. Primary urethral clearcell adenocarcinoma: comprehensive analysis by surgical pathology, cytopathology, and next-generation sequencing. Mixed mucinous and papillary adenocarcinoma involving male urethra, probably originating in periurethral glands. Clear cell adenocarcinoma of the female urethra: clinical and ultrastructural study suggesting a unique neoplasm. Clear cell adenocarcinoma of the urethra: a clinicopathologic analysis of 19 cases. Clear cell adenocarcinoma of the urethra-evidence for origin within paraurethral ducts. Clear cell adenocarcinoma of the female urethra showing positive staining with antibodies to prostatespecific antigen and prostatic acid phosphatase. Clear cell adenocarcinoma of the female urethra showing strong immunostaining for prostate-specific antigen. Histology and immunohistochemistry of clear cell adenocarcinoma of the urethra: histogenesis and diagnostic problems. Clear cell adenocarcinoma and nephrogenic adenoma of the urethra and urinary bladder: a histopathologic and immunohistochemical comparison. Clear cell adenocarcinoma of the bladder and urethra: cases diffusely mimicking nephrogenic adenoma. Metastatic clear cell adenocarcinoma of the urethra in a male patient: report of a case. Small cell carcinoma arising from the bulbar urethra: a case report and literature review. Malignant melanoma of the penis and male urethra: 4 case reports and literature review. Primary malignant melanoma of female urethra: report of a case and review of the literature. Primary malignant melanoma of the urethra: a clinicopathologic analysis of 15 cases. Melanoma of the penis, scrotum and male urethra: a 40-year single institution experience. Leiomyomata of the genitourinary tract: a case series from the "rare urological neoplasm" registry. Plasmacytoma of the urethra treated with transurethral resection and radiotherapy. Formation of the bipotential gonad-and subsequently the testis or the ovary-depends on gene expression in both sex and autosomal chromosomes. Testes secrete steroid and peptide hormones, both of which are necessary for the development of internal and external genitalia. These hormonal actions are mediated by specific receptors that function as transcription regulators. Alteration of genetic events results in sexual dimorphisms involving the internal and external genitalia and may hinder development of other organs. The subsequent cascade of genetic events leads to development of either female (ovaries) or male (testes) gonads, referred to as gonadal gender. Hormonal secretions from the ovaries or testes are essential for development of external genitalia, thereby determining phenotypic gender. The relationship between the individual and the environment determines social gender. The first phase is characterized by the appearance of the bipotential gonad, or genital ridge, which is an indifferent gonad that is identical in males and females. Development of the Bipotential Gonad Formation of the Gonadal Ridge In the fourth week of gestation the urogenital ridges appear as two parallel prominences along the posterior abdominal wall. This process is apparently driven by the expression of transcription factors Lim1 and Odd1. Each urogenital ridge gives rise to two important pairs of structures: the genital ridges arising from the medial prominences and the mesonephric ridges deriving from the lateral prominences. The genital ridges are the first primordium of the gonad, appearing as a pair of prominences about the midline. In 30- to 32-day embryos, each genital ridge is lateral to the aorta and medial to the mesonephric duct. The coelomic epithelium also proliferates to invade the subjacent mesenchymal tissue. The basement membrane underlying the coelomic epithelium appears discontinuous and is rich in laminin content. As the coelomic cells proliferate, laminin production in the gonadal ridge increases, an apparently essential element for germ cell colonization. Initially the genital ridges are devoid of primordial germ cells, but they are detected in the third week of gestation in the extraembryonal mesoderm that lines the yolk sac posterior wall near the allantoic evagination. Attracted by chemotactic factors, the primordial germ cells migrate along the mesenchyma of the mesentery and reach the genital ridge by 32 to 35 days. Primordial germ cells begin to express two membrane proteins, fragilis and brachyurus, and the cells migrate through the primitive streak to settle into the developing endoderm (hindgut). Primordial germ cells migrate by ameboid movements along the hindgut mesentery to reach the gonadal ridges. Once inside the genital ridge, germ cells lose their motility and begin to aggregate. In the upper corner of the image the lung can be recognized, and the liver is in front of the gonad. This expression occurs in the cytoplasm of somatic elements in the bipotential gonadal ridge. These clusters are fused and transformed into tubular structures that form the primitive testis cords. For such development to occur, specific interactions are necessary between germ cells, Sertoli cells, endothelial cells, macrophages, and interstitial cells. Shortly after formation of the gonadal blastema in male gonads, cells of the adjacent mesonephros begin to migrate to the gonadal blastema. The main emigration involves endothelial cells; they originate from the gonad-mesonephros border and migrate radially into the gonadal blastema parallel to the involution of the vascular mesonephric plexus from which they originate. Branches of this vessel penetrate the gonad, delimiting about 10 avascular domains that form the cords and subsequently the seminiferous tubules. They arise from primitive yolk sac­derived progenitors and initially are in direct contact with pre­Sertoli cells and germ cells. Undifferentiated cells may penetrate the gonad following the endothelial cells and differentiate into a population of Leydig cells. Primordial germ cells (that have proliferated in the seminiferous cords) that have undergone mitotic arrest in the G1 and G0 stages of the cell cycle are called gonocytes. Mitotic arrest depends on adequate cord formation and is probably mediated by inhibitory signals provided through gonocyte interactions with Sertoli cells. Initially, gonocytes are in the central ("luminal") portion of seminiferous cords. Later, during fetal and neonatal periods, gonocytes migrate toward the cord basement membrane because of gonocyte­Sertoli cell adhesion that is mediated by neural cell adhesion molecule. Near the end of the seventh week, pre­Sertoli cells differentiate from somatic cells in the sex cords, creating seminiferous cords. It was previously believed that interaction of peritubular myoid cells and pre­Sertoli cells was essential for seminiferous cord formation to promote basal lamina deposition and tubular organization.

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