A 67-year-old male patient, presented to the Department of Surgical Oncology with severe pain in his left knee and inability to walk since, 2 months. He had undergone a left radical nephrectomy one year ago for left Renal Cell Carcinoma (RCC) at our institute and the final histopathology was clear cell variant of RCC. Patient had been asymptomatic for the last 8 months and was not on any treatment after the surgery. Examination revealed a diffuse bulge in the region of the upper tibia and the ankle with restriction of the movement of the left leg. Diffuse tenderness was present around the lesion with a Visual Analogue Score (VAS) of 8-9/10. X-Ray (anterior-posterior and lateral view) of the knee suggested a complete destruction of the upper end of the metaphysis of the tibia with a soft tissue reaction. A working diagnosis of a metastatic deposit was made in view of the previous history of RCC.A Positron Emission Tomography (PET) scan was ordered to look for other areas of metastasis [Table/ Fig-1]. To our surprise there were only two areas of metastasis i.e., left upper end of tibia and the ankle. Fine Needle Aspiration Cytology (FNAC) of the soft tissue reaction showed the possibility of a poorly differentiated carcinoma, suspicious of a metastatic deposit from the RCC.With the above investigation, a decision of above knee amputation was taken, upon counseling the patient. The patient underwent planned procedure. Post-operative recovery and rehabilitation was uneventful. The final histopathology report revealed a RCC and was confirmed by immunohistochemistry [Table/ Fig-2]. Patient was started on adjuvant sunitinib 50mg daily per oral every day for four weeks with a gap of two weeks and was disease free at one year of follow-up. DisCussionBone metastases are more commonly seen in breast and prostate cancers, accounts for 60-70% of cases while lung, thyroid and RCC metastasize to bone in 30-40% of advance cases. Approximately one third of the newly diagnosed RCC presents with the synchronous metastasis disease and additional 30-40% patients develop metastasis eventually. The most common sites of metastatic RCC are the lung (75% of cases), liver (40%), bone (40%), soft tissue (34%), and pleura (31%) [1]. On a detailed pubmed search we found less than 20 cases of such cases. In the year 2010 three cases of tibia metastasis were reported from a retrospective study from Munich [2] and one case reported from India in 2012 [3].RCC has a high mortality rate, with a five year survival rate of <10%. The bone remains one of the most common distant metastatic sites of RCC either synchronous or metachronous presentation. The mechanism of tumour growth in bone is complex and involve tumour driven stimulation of osteoclast, osteoblast and other components of the bone, leading to significant patient morbidity due to the associated Skeletal Related Events (SREs). SREs are defined as pathological fractures, bone pain, impending fracture, spinal cord and nerve root compressions and hypercalcemia. SREs may significantly decrease ...

Sarcomatoid carcinomas are biphasic tumours, which occur at any site in the human body. It rarely affects the penis, with only 38 cases being reported in literature. It may be considered as a variant of squamous cell carcinoma or a dedifferentiated tumour. We report a 60-year old gentleman who presented with a swelling in the glans penis. He underwent a partial penectomy. Histopathology revealed sarcomatoid carcinoma of the penis, which was confirmed by immunohistochemistry. The rarity of this clinical entity makes its diagnosis difficult.

Cryptorchidism is the most common predisposing factor in the development of testicular germ cell tumors. Seminoma is the most common malignancy developing in a cryptorchid testis, usually has lymphatic but rarely hematogenous metastasis. The Urinary Bladder is an extremely rare site of metastasis of seminoma metastasis. A 29-year-old male patient presented to us with a history of infertility and an intra-abdominal mass. He was investigated and treated and was found to have an intra-abdominal seminoma with synchronous urinary bladder metastasis. He was treated with appropriate chemotherapy and continues to be in good health.

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Introduction: Urogenital fistula is a physically, socially and psychologically devastating condition. Although advances occurred in the understanding of etiology, pathogenesis, diagnosis, and management, it still poses challenges to the treating surgeon because of the controversies regarding the optimum time of repair and the ideal surgical approach. The objective of our study was to review cases of urogenital fistulae referred to our department over a 4-year period, with respect to etiology, types, management and outcome. Material and methods: This was a retrospective observational study between January 2013 to January 2017 which reviewed patient charts undergoing Genitourinary fistula repair at our Institute SVIMS, Tirupati for etiology, site, size and number of fistulae, clinical presentation, diagnostic modalities, and management. Results: A total of 49 women underwent genitourinary fistula repair at our institute between January 2013 to January 2017. The mean age of the patients was 39 years (19-58). Out of 49 cases, 35 cases were vesicovaginal fistulae (VVF), 3 fistulae were ureterovaginal, two fistulae were both VVF and ureterovaginal,7 fistulae were urethrovaginal and one vesicouterine fistula. Conclusion: Genitourinary fistulas are socially debilitating. High rates of successful fistula closure can be achieved irrespective of etiology by following sound surgical principles of fistula repair.