Lower Genitourinary Tract Research Articles

Batteries Included: A Case of Multiple Self-Inflicted Foreign Bodies in the Lower Genitourinary Tract

Batteries Included: A Case of Multiple Self-Inflicted Foreign Bodies in the Lower Genitourinary Tract

8610 The Role of Adenylyl Cyclase 2 Gene-Dosage Changes in Congenital Male Genitourinary Anomalies

Abstract Disclosure: D.J. Lamb: Advisory Board Member; Self; Ro Health, Inc. Stock Owner; Self; Fellow Health, Inc. M.A. O'Neill: None. Collectively, congenital genitourinary (GU) birth defects are the most common birth defects in males, yet relatively little is known about their cause. In part, this reflects the current clinical perspective that, because most of these birth defects can be surgically repaired, there is nothing to be gained by understanding the cause. Yet our studies show that seemingly simple birth defects like hypospadias or cryptorchidism, may be associated with other more significant underappreciated defects, such as those affecting the kidney, heart, eyes or behavior. We tested the hypothesis that chromosome microdeletions and microduplications (called copy number variations, CNVs) result in gene-dosage changes that are important regulators of GU development and when haploinsufficient or duplicated normal genitourinary development is impacted causing birth defects of the upper and/or lower genitourinary tract. We successfully used this strategy to identify 15 different previously unrecognized genes that when microduplicated or microdeleted result in conditions such as cryptorchidism, hypospadias, disorders of sexual differentiation (DSD) and other anomalies. Remarkably, gene-dosage changes affected major signaling pathways and post-translational modifications in novel, previously unrecognized ways. Herein, we focused on defining the role of a candidate gene commonly microdeleted or microduplicated in patients with cryptorchidism, hypospadias and/or micropenis. Locus mapping allowed identification of adenylate cyclase 2 (ADCY2) as a candidate gene at the 5p15.31 Cri-du-Chat region in patients with male genital tract anomalies. ADCY2 CNVs were more common in non-syndromic patients with micropenis, cryptorchidism, and/or hypospadias (1.6%) than the general population (0.07%; p< 0.001). Whole exome sequence studies revealed a range of phenotypic anomalies in patients with damaging and potentially damaging ADCY2 variants in addition to the male GU anomalies, including congenital anomalies of the kidney and urinary tract. It is our hypothesis that ADCY2 duplications result in a de-sensitization of the LH receptor diminishing testosterone biosynthesis in the testis, whereas deletions diminish LH receptor signaling. ADCY2 CNVs were assessed in 100 men with spermatogenic failure who were born with cryptorchidism. The ADCY2 CNV frequency was the same as in our cohort of boys with GU anomalies, but as adults they also have hypergonadotropic hypogonadism, which we predicted if ADCY2 over-expression was impacting adult Leydig cell steroidogenesis through partial desensitization of the LH receptor. These studies identified an unrecognized cause of GU anomalies. In the future, such knowledge may lead to improved diagnosis and therapeutic approaches to ameliorate these common birth defects. Presentation: 6/2/2024

Expression and clinicopathologic significance of HER2 and PD-L1 in high grade urothelial carcinoma of the urinary tract.

Urothelial carcinoma (UC) is an aggressive tumor with high recurrence rates and poses a great challenge for clinical management. Programmed death ligand-1 (PD-L1) inhibitors and human epidermal growth factor receptor 2 (HER2) blockers have been approved for the treatment of advanced urothelial carcinoma. PD-L1 and HER2 expression in UC will determine whether patients are likely to respond to these targeted treatments. This study assessed the expressions of HER2 and PD-L1 in UC at our institution and investigated their correlations with gender, tumor location (upper genitourinary (GU) tract vs. lower GU tract), tumor stage, and histologic divergent subtypes. Patients with UC who had PD-L1 or HER2 immunostains performed in the past 3 years at our institution were included in our analysis. A total of 97 cases were identified. PD-L1 and HER2 scores were provided by two experienced GU pathologists. HER2 scores were given according to the criteria used in breast cancer, while PD-L1 scores were reported as the combined positive score. We assessed correlation of the scores with the patients' gender, tumor location, tumor stage, and histologic divergent subtypes. The data for PD-L1 expression were analyzed using the Mann-Whitney U Test for gender and urinary tract location, and one-way analysis of variance (ANOVA) for stage and histology. The data for HER2 expression were analyzed using the chi-square test. For all analyses, significance was set at P<0.05. Of the 97 patients, the average age was 69 years. There were 95 patients who had previously reported HER2 results and 86 patients who had PD-L1 results. PD-L1 expression did not show a significant difference among the histological divergent subtypes (P=0.36). However, HER2 status exhibited a significant difference, with more HER2-positive cases observed in the conventional histology (P=0.008). No correlation between HER2 status and either gender or tumor stage was identified. The median PD-L1 combined positive score was significantly higher in lower urinary tract UC than upper (10 and 2, respectively; P=0.049). No significant differences were observed for gender or pathologic stage. Our data suggest that HER2 is more frequently expressed in conventional UC than in divergent subtypes. Additionally, PD-L1 has a higher expression level in lower urinary tract UC compared to upper. However, PD-L1 and HER2 expression are not related to gender or tumor stage in UC.

HIV-1 diversity and compartmentalization in urine, semen, and blood.

HIV-1 persists indefinitely in multiple cellular reservoirs despite antiretroviral therapy. We previously demonstrated HIV-1 compartmentalization in kidney and urine. Here, we further characterized viruses in urine and when available, compared them to those present in semen from HIV-1 positive participants with detectable plasma viremia to further understand the viral dynamics in the upper and lower genitourinary tract.Blood and urine samples were obtained from 19 HIV-1 positive participants. Simultaneous semen samples were obtained from 16 of the 19 participants. HIV-1 envelope (env) gene sequences were obtained by single-genome amplification (SGA) and neighbor-joining trees were constructed using the Kimura 2-parameter model.HIV-1 env gene sequences were amplified from blood in 19/19 (100%) participants, urine in 18/19 (95%) participants, and semen in 12/16 (75%). In individuals from which both urine and semen samples were obtained, differences in viral shedding between the 2 sources were observed, where HIV-1 env sequences could only be amplified from either urine or semen. Longitudinal phylogenetic analysis of urine-derived env sequences from 1 participant demonstrated that urine clusters distinct from blood are maintained over time (20 weeks), consistent with viral compartmentalization and local replication. Comparison of urine and semen derived sequences demonstrated either virus compartmentalization or equilibration.Our results demonstrate that when present, viral compartmentalization in urine persists over time. Comparison of timing of viral shedding in urine and semen samples from our cohort suggest different viral kinetics between the upper and lower genitourinary tract and sequence analysis suggests that HIV-1 populations in urine and semen can either be imported from blood or produced locally.

An Unusual Self-Inflicted Foreign Body in the Urinary Bladder and Urethra: A Case Report

Introduction: Most foreign bodies in the lower genitourinary tract are self-inserted via the urethra as the result of exotic impulses, psychometric problems, sexual curiosity, or sexual practice while intoxicated. Diagnosis of these foreign bodies can be done by clinical history, physical examination, and image studies of the patient. The treatment of foreign bodies is determined by their size, location, shape, and mobility. In most cases, minimally invasive procedures such as endoscopic removal are recommended to prevent bladder and urethral injuries. In some cases, however, surgical treatment should be done if the foreign bodies cannot be removed by the endoscopic procedure or further injuries are expected as a result of the endoscopic procedures. Case Presentation: Herein we present a case of self-inserted lower genitourinary foreign body. A 60 years old man presented with complaints of dysuria, dribbling, haematuria and suprapubic pain for 3 weeks. An X-ray of the pelvis showed a coiled up radio opaque shadow of telephone wire in the bladder region extending downwards which was removed by suprapubic cystostomy. Discussions: Bladder foreign body is not common. Plain radiograph is sufficient to diagnose and minimally invasive procedure is usually successful. In this case retrieval by cystostomy was done to avoid the risk of bladder and urethral injury. Conclusion: Introduction into the bladder may be through self-insertion, iatrogenic means or migration from adjacent organs. Extraction should be tailored according to the nature of the foreign body and should minimize bladder and urethral trauma. The possibility of an intravesical foreign body should be considered in any patient with chronic unexplained lower urinary tract symptoms. Bangladesh Journal of Urology, Vol. 18, No. 2, July 2015 p.94-97

Hollow Viscus Injuries Due To Trauma

Background: Hollow viscus injuries can be due to traffic accidents, fall from the height, and fall of heavy objects leading to trauma. Abdominal trauma is the most common with Injuries pertaining to Gastro-Intestinal tract from the cardiac end of the esophagus to the anus, gall bladder, and biliary tract and lower genitourinary tract. The aim of the study is to study the modes of trauma, clinical features of hollow viscus injuries, and the diagnosis and management of hollow viscus injuries. Subjects and Methods: This was a hospital-based cross-sectional study. conducted over a period of one year from June 2018 – May 2019. at Department of General Surgery on 90 patients with hollow viscus injury. After initial resuscitation of the trauma victims, a careful history was taken to document any associated medical problem. The collected data was analyzed with respect to the presentation by the patient’s age and sex incidence, etiologies, pathological features, morbidity, and mortality associated with causation and management. The ultrasound and CT- Scan were done to assess the injury and plan accordingly before taking up for the surgery. Results: The majority of the patients belonged to the age group of 21 – 30 years and the least pertaining to the age group of 41 – 50 years of age group. The Incidence in Males is much more than females. The males were 74% and females were 26%. The most common causative agent of hollow viscous injury was a Road traffic accident with 59%. Majority of the patients who were admitted more than 24 hours after the injury, the mortality rate was much higher compared to the patients who were admitted in less than 24 hours of the trauma. Conclusion: HVI is a dangerous condition. High mortality rates represent the seriousness of HVI and related injuries. Patients of HVI should be carefully monitored for associated injuries and complications.

Persistence of spermatozoa in the lower genitourinary tract after elapsed time: Should the guidelines be reframed?

Persistence of spermatozoa in the lower genitourinary tract after elapsed time: Should the guidelines be reframed?

Unusual Foreign Bodies in the Lower Genitourinary Tract

Foreign body in the lower genitourinary tract is a relatively rare occurrence. A variety of foreign bodies have been reported in the literature. Commonly reported condition under which foreign bodies are introduced into genitourinary tract is autoeroticism. The highest incidence occurs in homosexuals, lesbians and masochism. But self-introduction of foreign body in the vagina in a 5-year-old girl is an extremely rare occurrence. Here we report two cases of self-inserted lower genitourinary foreign body in two different ages.J Enam Med Col 2018; 8(2): 105-107

β3-Adrenoceptor Control of Lower Genitourinary Tract Organs and Function in Male: An Overview.

The sympathetic nervous system is one component of the nervous regulatory system of the physiological function of the lower genitourinary tract. Our knowledge on the role of this sympathetic system has advanced during the last decade due to the characterization of β3-adrenoceptors (β3-ARs) in the urogenital system. This review focuses on the pharmacological and molecular evidence supporting the functional roles of β3-AR in male genitourinary tissues of various species. An electronic search in two different databases was performed including MEDLINE (PubMed) and EMBASE from 2010 to 2016. β3-agonists may be a promising alternative to antimuscarinics in the treatment of overactive bladder (OAB) based on available evidence. Although more recent studies have evaluated the involvement of β3-ARs in the physiological control and regulation of various tissues of the lower genitourinary tract mainly urinary bladder, penis, urethra, ureter, there are few innovations in the pipe-line. Among the β3-agonists, mirabegron is a unique drug licensed for the treatment of patients with OAB. Many drugs classified as β3-agonists are still under investigations for the treatment of OAB, lower urinary tract symptoms, ureteral stones, benign prostate hyperplasia, prostate cancer and erectile dysfunction. This review discusses the potential roles of β3-AR as new therapeutic targets by evaluating the results of preclinical and clinical studies related to male lower genitourinary tract function. Looking into the future, the potential benefits of β3- AR agonists from experimental and clinical investigations may provide an attractive therapeutic option.

162 Dysregulated NO Signaling in the Lower Genitourinary Tract: A Common Mechanism of Erection and Micturition Dysfunction in a Mouse Model of Sickle Cell Disease

Sickle cell disease (SCD) is a state of chronic nitric oxide (NO) deficiency. Priapism, a disorder of non-willful, excessive penile erection, is a highly prevalent complication of SCD. The principal molecular defects underlying priapism in SCD include reduced NO/cGMP/PDE5 bioavailability in the penis related to decreased endothelial NO synthase (eNOS) activity. Recently, urinary dysfunction, including nocturnal enuresis and overactive bladder, have been clinically observed in SCD patients, but the mechanisms underlying urinary dysfunction in SCD are unknown. We hypothesized that aberration in NO regulatory signaling is a common pathophysiologic mechanism for concomitant erection and voiding disorders in SCD. 3 month old SCD (Sickle) and wild type (WT) male mice were used. Erectile function measurement (intracavernosal pressure/mean arterial pressure) and cystometric studies were performed. Bladder and urethra were collected from separate groups of Sickle and WT mice for organ bath studies or measurement of protein expressions of phospho (P)-eNOS (Ser-1177) and P-nNOS (Ser-1412) protein expression by Western immunoblot.

BLUE LIGTH EMITTING DIODE IN TREATMENT OF RECURRING VULVOVAGINAL CANDIDIASIS: A CASE REPORT

Introduction: Recurring vulvovaginal candidiasis (RVVC) is an infectious disease of the lower genitourinary tract, that occurs at least 4 times per year. Drug treatment can last months and favor the appearance of adverse effects and increase the chances of recurrence. Blue Light Diode (LED) is an electromagnetic spectrum light, with antimicrobial functions. Case Report: A case report was made of a patient with RVVC whose treatment consisted of three sessions of 60-minutes each, of application of blue LED in intervals of 15 days. Evaluation was carried out before, at the end of third application and three months after the last session by means of fungal culture, cervical cytology; analysis of patient´s clinical condition; and measurement of vaginal pH. After the third session, there was a reduction in fungal load and vaginal pH; absence of symptoms (pruritus, burning and dyspareunia) and vulvovaginal edema, but there were no alterations in the cytology and microflora, which remained with inflammatory markers. Three months after the end of the treatment, there was no Candida in vaginal secretion, neither signs nor symptoms of candidiasis, and vaginal pH was normal. As for cytology and microflora, cellular alterations associated with cytolysis and presence of lactobacilli was observed. Conclusion: The blue LED 401 nm may be a promising alternative to treat RVVC by eliminating signs and symptoms in women.

Sexual Function in Women Suffering From Genitourinary Syndrome of Menopause Treated With Fractionated CO2 Laser.

Genitourinary syndrome of menopause (GSM) has a significant impact on the trophism of the genital and lower urinary tracts and can considerably impair sexual function. Fractional CO2 laser has a regenerative effect on vulvovaginal tissue trophism after menopause. To review the available literature on the effect of fractional CO2 laser on the sexual function of postmenopausal women affected by GSM. A database search was carried out using the terms CO2laser, vaginal atrophy, sexual function, dyspareunia, and genitourinary syndrome of menopause and excluding studies using other types of laser or including breast cancer survivors with vulvovaginal atrophy. For statistical analysis, the estimated overall laser effect was computed (when at least two studies were involved) and data type of generic inverse variance was computed using inverse variance as the statistical method, a random-effects model, and the difference in means as an effect measurement. Different methods of evaluating sexual function were reported and studies were grouped and analyzed accordingly. Subjective assessment for dyspareunia was evaluated with a 10-point visual analog scale. Patient-reported outcome for an overall perception of sexual function was evaluated with a Likert scale. The Female Sexual Function Index was used as a condition-specific questionnaire. Six articles were considered for this review. A total of 273 women (mean age= 57.8 years) were treated with the same protocol in all studies. Compared with baseline, at the end of the treatment, dyspareunia significantly decreased in severity (P < .001), and the patient's perception of overall sexual function showed a statistically significant improvement (P < .001). At the last follow-up visit, the Female Sexual Function Index score for each single domain and overall score was significantly better than at entry (P < .001). Fractional CO2 laser can improve sexual function in postmenopausal women affected by GSM by restoring a better trophism in the lower genitourinary tract. Salvatore S, Pitsouni E, Del Deo F, etal. Sexual Function in Women Suffering From Genitourinary Syndrome of Menopause Treated With Fractionated CO2Laser. Sex Med Rev 2017;5:486-494.

Murine model indicates 22q11.2 signaling adaptor CRKL is a dosage-sensitive regulator of genitourinary development

The spectrum of congenital anomalies affecting either the upper tract (kidneys and ureters) or lower tract (reproductive organs) of the genitourinary (GU) system are fundamentally linked by the developmental origin of multiple GU tissues, including the kidneys, gonads, and reproductive ductal systems: the intermediate mesoderm. Although ∼31% of DiGeorge/del22q11.2 syndrome patients exhibit GU defects, little focus has been placed on the molecular etiology of GU defects in this syndrome. Among del22q11.2 patients exhibiting GU anomalies, we have mapped the smallest relevant region to only five genes, including CRKLCRKL encodes a src-homology adaptor protein implicated in mediating tyrosine kinase signaling, and is expressed in the developing GU-tract in mice and humans. Here we show that Crkl mutant embryos exhibit gene dosage-dependent growth restriction, and homozygous mutants exhibit upper GU defects at a microdissection-detectable rate of 23%. RNA-sequencing revealed that 52 genes are differentially regulated in response to uncoupling Crkl from its signaling pathways in the developing kidney, including a fivefold up-regulation of Foxd1, a known regulator of nephron progenitor differentiation. Additionally, Crkl heterozygous adult males exhibit cryptorchidism, lower testis weight, lower sperm count, and subfertility. Together, these data indicate that CRKL is intimately involved in normal development of both the upper and lower GU tracts, and disruption of CRKL contributes to the high incidence of GU defects associated with deletion at 22q11.2.

TRATAMENTO DA CANDIDÍASE VULVOVAGINAL E NOVAS PERSPECTIVAS TERAPÊUTICAS: UMA REVISÃO NARRATIVA

Introdução: A candidíase vulvovaginal (CVV) é um processo infeccioso do trato geniturinário inferior feminino causada pelo fungo Candida. No Brasil, é o segundo diagnóstico mais comum em ginecologia e tem ocasionado preocupação dos profissionais da saúde devido ao crescente número de casos recorrentes. A dificuldade na abordagem terapêutica da CVV aponta para a relevância do desenvolvimento de estudos que abordem as atuais terapias utilizadas para esta infecção e suas limitações, atentando os profissionais da área a desenvolver a visão crítica acerca do tema e buscar modificações no manejo clínico. Objetivo: Este estudo visa descrever o panorama atual dos tratamentos da CVV e as novas perspectivas terapêuticas. Estratégia Metodológica: Foi desenvolvida uma revisão de literatura contendo artigos em língua inglesa e portuguesa acerca dos atuais tratamentos existentes para CVV e possíveis perspectivas terapêuticas. Resultados: Nota-se que os casos de CVV, principalmente os recorrentes, têm apresentado limitação na resposta aos tratamentos medicamentosos atuais e por isto há uma crescente busca por inovações terapêuticas. Dentre as novas possibilidades, o Diodo Emissor de Luz (LED) azul 405 nm é uma possível modalidade de tratamento, no entanto, necessita-se de mais estudos que comprovem sua eficácia. Conclusão: A terapia antifúngica atual tem apresentado limitações, principalmente nos casos de recorrência e isto fortalece a necessidade de busca de novas modalidades terapêuticas que sejam capazes de tratar o processo infeccioso inibindo os mecanismos de resistência do microorganismo.

Suprapubic Catheter Placement in Lower Genitourinary Tract Injury: Friend or Foe?

Suprapubic Catheter Placement in Lower Genitourinary Tract Injury: Friend or Foe?

Occurrence of and Risk Factors for Urological Intervention During Benign Hysterectomy: Analysis of the National Surgical Quality Improvement Program Database

To determine the occurrence of lower genitourinary tract (LGUT) injury during hysterectomy for benign disease and identify risk factors for LGUT injury, with a specific focus on the effect of hysterectomy modality. We performed a retrospective cohort study of patients undergoing hysterectomy for benign disease from 2010 t o 2014 using the American College of Surgeons National Surgical Quality Improvement Program, a multi-institutional prospective registry that captures perioperative surgical outcomes. We identified the occurrence of concomitant cystoscopy and therapeutic urologic interventions including endoscopic ureteric stenting, ureteric repair, bladder repair, cystectomy, and urinary diversion as a proxy for LGUT injuries. Adjusted odds ratios and 95% confidence intervals were calculated using multivariate logistic regression. We identified 101,021 patients treated with hysterectomy for benign disease: 18,610 (18.4%), 27,427 (27.2%), and 54,984 (54.4%) underwent vaginal, open, and laparoscopic hysterectomy, respectively. Cystoscopy was performed in 16,493 cases (16.3%). There were 2427 patients (2.4%) who underwent concomitant urologic intervention. Patients undergoing laparoscopic hysterectomy had increased occurrence of urologic intervention, excluding cystoscopy (adjusted odds ratio 1.47, 95% confidence interval 1.29-1.69), compared to vaginal hysterectomy; no differences were found between open and vaginal hysterectomy or laparoscopic and open hysterectomy. Larger uteri, a postoperative diagnosis of endometriosis, increasing comorbidity, and African American race were associated with an increased odd of urologic intervention whereas concomitant cystoscopy was associated with a decreased chance. The incidence of lower genitourinary tract intervention in benign hysterectomy is significant and may be higher than previously reported. Predisposing patient factors and operative technique are key risk factors.

Unveiling Penile Rhabdomyosarcoma

Stated purpose: Rhabdomyosarcomas are a heterogeneous group of malignant tumors representing the most common soft tissue sarcoma in lower genitourinary tract mostly occurs in infants and children in the first 2 decades of life. It is a rare and potentially deadly malignant mesenchymal neoplasia mainly originating from immature striated muscle. Rhabdomyosarcoma cells tend to appear rod-shaped, having an identifiable striated muscular differentiation with rhabdomyoblasts cells. Clinical guidelines and treatment of these tumors are very difficult because rhabdomyosarcomas behave extremely different and requires an early diagnosis and therapeutic modalities involving surgery, chemotherapy and radiation therapy. Material & Methods: In the present study, the authors report a rare case of Grade-II Penile Rhabdomyosarcoma diagnosed in a 2-year male child and have explored the histopathological literature and treatment options for this rare entity. Conclusion: We summarized the results from the available data to the published findings which have recently reported for the proven case of grade-II rhabdomyosarcoma of the penis with treatment options for this rare entity. Considering the limited number of cases reported till now, the conclusions about treatment and prognosis are equivocal. Finally the authors concluded that penile sarcomas are rare tumors with poor prognosis when they involve deep-seated lesions.

Self-inflicted foreign bodies in lower genitourinary tract in males: Our experience and review of literature.

Objectives:To study retrospectively the frequency, demographic, phenomenological, and psychiatric profile in patients presented with self-insertion of foreign bodies in the lower genitourinary tract in our institute.Materials and Methods:From January 2009 to 2015, the records of patients admitted with self-insertion of foreign bodies into the lower urinary tract were analyzed retrospectively regarding demographic and phenomenological profile, the mode of presentation, diagnosis, management, complications, and possible contributing factors leading to the event.Results:Out of 17,978 inpatients, ten patients (0.055%) presented with foreign body insertion in the lower genitourinary tract in last 6 years. Mean age was 28.1 ± 13.9 (7–50) years. Objects used for insertion were varied from seeds, twigs to the electric wire. The contributing factors were lack of partner, misconception about masturbation, and underlying psychiatric illness. The presenting symptoms were pain and swelling of the penis, difficulty in voiding, and skin ulceration. The diagnosis was possible by simple observation in four patients, X-ray kidney, ureter, and bladder, and sonography of the pelvis in six patients. Five patients had endoscopic retrieval of foreign body, 2 had an open, suprapubic cystotomy, urethrotomy was needed in one patient, and forceps removal in two patients. There were no postoperative complications. Psychiatric profile was evaluated in nine patients.Conclusions:Foreign body insertion to lower urinary tract was rare. A main cause for insertion of foreign bodies was autoerotism, misconceptions regarding masturbation, and underlying psychiatric illness. In addition to suitable method of surgical removal, counseling and psychiatric evaluation are necessary to prevent recurrences or for early detection of psychiatric problems.

Mycobacterial inflammatory pseudotumour of the neck – a potential diagnostic pitfall

Inflammatory pseudotumour has been applied to a group of diverse entities including inflammatory myofibroblastic tumour, pseudosarcomatous reparative lesions such as myofibroblastic proliferation of the lower genitourinary tract, infectious lesions and inflammatory-follicular dendritic cell neoplasm. Within the group of inflammatory lesions, mycobacterium is known to result in a histiocytic proliferation resembling a soft tissue neoplasm. In this report, we detail an instance of mycobacterial inflammatory pseu-dotumour affecting a 40-year-old Chinese man with a known history of retroviral disease and mycobacterium avium-intracellulare (MAI) infection. He presented with diffuse lymphadenopathy for a year while on antibiotic therapy for MAI. On CT scan, multiple enlarged lymph nodes were noted in the neck, thorax and abdomen. As there was a clinical suspicion of malignancy, namely lym-phoma, excision of the left cervical lymph node was performed. On histology, there was diffuse and predominant proliferation of spindle cells with a sprinkling of lymphocytes and plasma cells, simulating a mesenchymal tumour. Ziehl-Neelsen stain revealed an abundance of acid fast bacilli and immunohistochemistry stain for CD163 confirmed the spindle cells to be histiocytic in origin. The diagnostic problems associated with a mycobacterial inflam-matory pseudotumour are presented.

Radiological Evaluation of Lower Genitourinary Tract Cysts in Males

Aim of the Work: The present wok aims to assess how to reach the optimum diagnosis of the nature and the complications of lower genitourinary tract cyst in male patient using different radiological imaging modalities. Patients and Methods: 1000 male patients were evaluated with pelvic ultrasound and if lower genitourinary tract cysts were present, the patients were further subjected to either trans-rectal ultrasound (TRUS), TRUS guided aspiration for presence of spermatozoa, TRUS guided seminal vesiculography or CT urography in order to reach the origin of the cyst and the complications of its presence. Results: 14 cases were detected with lower genitourinary tract cysts among our patients with an overall incidence 1.4%; among them 3 patients with mid line prostatic cysts showed normal seminal analysis; 1 patient with prostatic cyst was infertile; 3 patients were detected with infravesical cysts after transurethral resection prostatectomy; 2 cases with small retention cysts were associated with benign prostatic hyperplasia; 1 case was detected with prostatic abscess; 1 patient was detected with unilateral ureterocele; 1 patient was detected with large pelvi abdominal unilateral seminal vesicle cyst; 1 patient was with unilateral ejaculatory duct cyst; 1 patient with small cystic dilation of prostatic urethra was associated with urethral stone.