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Rhabdomyosarcoma (RMS) is among the most common pediatric solid malignancies. Fusion-negative, embryonal RMS is the predominant histology among prostate and bladder lesions. Management strategies depend on the clinical stage and risk group. Although the optimal strategy continues to evolve, the field has transitioned from radical upfront resection to organ preservation strategies with multi-modal therapy, including chemotherapy, radiation, and surgery. Survivors frequently develop late complications, including impaired fertility and sexual function, bladder dysfunction, and secondary malignancies. Our case describes an 11-year-old male who developed a radiation-induced prostatic sarcoma. We present a novel surgical technique and highlight the importance of multidisciplinary care.

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INTRODUCTION: Penile adhesions are a common complication of neonatal circumcision and can cause significant distress to families. Although prior studies have suggested adhesions resolve with conservative measures, the information on the likelihood and time frame is not known. Alternatively, a lysis of adhesions (LOA) procedure can be performed in the office. The aim of the study was to determine the likelihood of spontaneous resolution with conservative measures at home. METHODS: A retrospective review of patients with post circumcision penile adhesions that were referred to a pediatric urologist was conducted. Data regarding patient age, extent and severity of adhesions, chosen treatment modality (home-care with daily retraction versus LOA), improvement in subsequent visits, and final outcome of adhesions was obtained from chart review. Contingency tables, chi-square tests, or t-tests were used to assess statistical significance. RESULTS: 429 patients were reviewed. The mean age was 28.2 months (range 1-152) and mean follow-up was 7.4 months (range 1-70). Adhesions were circumferential in 81% of patients and incomplete in 19%. Additionally, 64% of patients had adhesions that covered less than 50% of the glans penis, compared to adhesions that covered 50% or more in 36% of patients. After the initial visit, 66% of patients elected the home-care regimen, 89% of which were seen in follow-up visits. Only 36% of patients treated with the home-care regimen had completely or substantially resolved adhesions after a median of 6 months. Results showed a significant difference in success with home care depending on the circumferential extent of adhesions (p < 0.05), with patients whose adhesions covered less than 25% of the glans penis having the greatest likelihood of improvement. Effectiveness of home therapy also varied depending on the severity of adhesions (p < 0.05), with patients whose adhesions covered less than 50% of the glans having a higher chance of success. Most patients that initially chose the home-care regimen (65%) eventually elected to undergo LOA in the office. This study is limited by the retrospective nature, failure to control for potential confounders such as weight and the degree of participation at home, and the time frame after initiation of home therapy, which might have been insufficient for complete resolution of adhesions. DISCUSSION: The conservative management of post-circumcision adhesions is not effective over a 6 month time frame, with the great majority of the patients eventually undergoing LOA. Physicians can classify the severity and extent of adhesions to predict what patients might have more success with conservative management. LOA might be better suited for patients with more severe adhesions.

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Metastasis of hepatocellular carcinoma (HCC) to the seminal vesicle is extraordinarily rare, with only two other cases reported in the literature. Herein we present the first documented case of a seminal vesicle as the initial site of solitary metastasis in a patient with a history of liver transplantation for HCC. We aim to provide more information regarding the disease process, histopathology, and management strategy.

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Prostate cancer (PCa) is the most commonly diagnosed non-cutaneous cancer. In the United States it is second leading cause of cancer related deaths in men. PCa is often treated via radical prostatectomy (RP). However, 15-30% of the patients develop biochemical recurrence (i.e. increased serum prostate specific antigen (PSA) levels). Interleukin-15 (IL-15) is a secreted cytokine found over expressed in patients with recurrence-free survival after RP. In our study, we aim to determine the role of IL-15 in PCa using in vitro and in vivo models, and gene expression analysis. PC3 (androgen-independent) and 22RV1 (androgen-dependent) cell lines were treated with IL-15 at 0.0013 ng/mL and 0.1 ng/mL. Tumor growth was evaluated using an orthotopic xenograft model. The anterior prostate lobes of SCID mice were injected with 250,000 22RV1 cells and IL-15 was administered bi-weekly with intraperitoneal (IP) injections during 4 weeks. Tumor tissue was collected for immunohistochemical and gene expression analysis. To study changes in gene expression, we looked at "Tumor Metastasis" and "PI3K pathway" using commercially available PCR arrays. In addition, we employed a microarray approach using the Affymetrix Hugene 2.0 ST array chip followed by analysis with Ingenuity Pathways Analysis (IPA) software. In vitro studies showed that IL-15 decreased PCa cell motility at both concentrations. In vivo studies showed that IL-15 increased neutrophil infiltration, and the expression of adiponectin, desmin and alpha smooth muscle actin (α-sma) in the tumor tissue. Angiogenesis analysis, using CD31 immunohistochemistry, showed that IL-15 decreased the number of blood vessels. Gene expression analysis identified Cancer, Cell Death, Immune Response and Lipid Metabolism as the major diseases and functions altered in tumors treated with IL-15. This suggests that IL-15 causes inflammation and changes in stroma that can promote decreased tumor cell proliferation.

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