Anterior pelvic exenteration and synchronous bilateral nephroureterectomy for BK polyoma virus induced urothelial carcinoma of the bladder: A case report

BK polyoma virus (BKV) is a known risk factor for the development of urothelial carcinoma. There is currently limited data on the management of BKV-induced urothelial carcinoma (BUC) of the bladder, with available data limited to case reports. It remains debatable whether radical cystectomy (RC) with removal of the native urinary tract or RC alone is the most optimal management for BUC of the bladder. BKV-induced urothelial carcinoma is rare, and its management is challenging in immunocompromised patients such as that of post-transplant patients. This case report provides additional insight into a rare disease, the management of which still lacks established guidelines and remains debatable. We present a unique case of BKV-induced muscle-invasive urothelial carcinoma of the bladder in an immunosuppressed renal transplant patient who underwent open radical cystectomy, anterior pelvic exenteration, bilateral native nephroureterectomy and ileal conduit formation to transplant kidney. The patient remains recurrence-free with preserved graft function 2 years since surgery. An aggressive management approach which involves anterior pelvic exenteration with removal of the native urinary tract may be favoured in young patients with BUC of the bladder with minimal comorbidities. However, treatment should be individualised for each individual patient.</jats:p

Anterior pelvic exenteration and synchronous bilateral nephroureterectomy for BK polyoma virus induced urothelial carcinoma of the bladder: A case report

BK polyoma virus (BKV) is a known risk factor for the development of urothelial carcinoma. There is currently limited data on the management of BKV-induced urothelial carcinoma (BUC) of the bladder, with available data limited to case reports. It remains debatable whether radical cystectomy (RC) with removal of the native urinary tract or RC alone is the most optimal management for BUC of the bladder. BKV-induced urothelial carcinoma is rare, and its management is challenging in immunocompromised patients such as that of post-transplant patients. This case report provides additional insight into a rare disease, the management of which still lacks established guidelines and remains debatable. We present a unique case of BKV-induced muscle-invasive urothelial carcinoma of the bladder in an immunosuppressed renal transplant patient who underwent open radical cystectomy, anterior pelvic exenteration, bilateral native nephroureterectomy and ileal conduit formation to transplant kidney. The patient remains recurrence-free with preserved graft function 2 years since surgery. An aggressive management approach which involves anterior pelvic exenteration with removal of the native urinary tract may be favoured in young patients with BUC of the bladder with minimal comorbidities. However, treatment should be individualised for each individual patient

Sedimentary Melanges and Fossil Mass-Transport Complexes: A Key for Better Understanding Submarine Mass Movements?

Mélanges originated from sedimentary processes (sedimentary mélanges) and olistostromes are frequently present in mountain chains worldwide. They are excellent fossil examples of mass- Transport complexes (MTC), often cropping out in well-preserved and laterally continuous exposures. In this article we will show the results of the integrated study of fossil MTCs, including sedimentary mélanges/ olistostromes, with a focus on the Apennines of Italy. Fossil MTCs, especially the basin-wide ones, are composite and multi-event units involving the entire spectra of mass- Transport processes. The down-slope motion of these bodies is enabled by the relative movement of discrete masses, with progressive stratal disruption of rocks/sediment involved and flow transformation. Three kinds of MTC are here distinguished, in which the movements are enabled by (1) shear-dominated viscous flows within a muddy matrix, (2) mud-silt-sandy matrix sustained by fluid overpressure, (3) concentrated shear zones/surfaces with advection of grains and fluid (overpressured basal carpets). These MTC types may represent end-members of a continuum of products and correspond to different kinematics of transport and emplacement and to different relationship with the substratum. These observations should result in a better knowledge of mass- Transport processes and bodies, in relation with the basin floor geometries. © Springer Science+Business Media B.V. 2012