Background: Genitourinary small cell cancer (GUSCC) is a rare malignancy. Most of the published data on how to manage this malignancy is based on institutional experience. We undertook the current retrospective review to determine the outcome of the patients with GUSCC treated at CancerCare Manitoba, Canada over a period of 18 years.Methods: The Manitoba Cancer Registry was used to identify patients with a confirmed pathological diagnosis of small cell cancer (SCC) of the bladder or prostate between January 1, 1995, and October 31, 2013.Results: There were 42 patients identified, 28 bladder SCC (17 limited, 11 extensive stage) and 14 prostate SCC (one limited, 12 extensive, and one unknown stage). The median age was 70.7 years. There were 22 patients who were treated with chemotherapy and radiation, five received radiation only, four received chemo only, nine did not receive any treatment, one patient had surgery only, and one had surgery and radiation. The median and one-year overall survival for all patients was 10.7 months and 43%. The median and one-year overall survival of SCC of the bladder was 55.1 months and 71% for the limited stage and 10.1 months and 36% for the extensive stage. The median and one-year overall survival for extensive stage SCC of the prostate was 4.1 months and 17%. There was only one patient with limited stage SCC of the prostate who did not receive any treatment and died of progressive disease 11 months from diagnosis.Conclusions: Our findings suggest that patients with limited stage SCC of the bladder can have a surprisingly good outcome with multimodality treatment. The outcome of the patients with extensive stage SCC of the bladder and prostate remains dismal and optimal therapeutic options have yet to be determined.

Penile cancer is a rare malignancy that typically presents as a superficial lesion. We present an interesting case of subepithelial penile cancer presenting without superficial manifestation.

Testicular germ cell tumours (TGCT) are a rare malignancy that affect primarily young men. We present an interesting case of nonseminoma testicular cancer treated with external beam radiation therapy (RT), which subsequently resulted in two separate secondary malignancies decades after initial treatment. Case reportAt the age of 16, the patient underwent surgical correction of bilateral undescended testicles. Ten years later, he was found to have a left testicular mass and underwent a left radical inguinal orchiectomy revealing a malignant teratoma. Surgery and 25 rounds of adjuvant RT resulted in cure. He has been managed uneventfully with testosterone throughout his adult life due to an atrophic right testicle.Forty four (44) years after orchiectomy and RT, the patient presented to the emergency department with gross hematuria and flank pain. A computed tomography (CT) scan was performed, demonstrating a 2.8 x 1.7 cm mass in the renal pelvis consistent with urothelial carcinoma, and a small pulmonary nodule was noted in the lower right lung. Cystoscopy revealed no evidence of lower tract pathology. The patient underwent a laparoscopic left radical nephroureterectomy and retroperitoneal lymph node dissection with endoscopic bladder cuff excision. Pathology revealed a pT1b, N1, MX, high-grade urothelial tumour with focal necrosis. Three of 11 nodes were positive for urothelial carcinoma; lymphovascular invasion was not noted.In light of the poor prognosis and high risk of recurrence, adjuvant chemotherapy of cisplatin/gemtabicine was offered, but was declined by the patient. The patient recovered quite well apart from noting intermittent hematochezia that began approximately 10 weeks after his surgery. Follow up CT scan performed two months after surgery identified enlargement of the small pulmonary nodule from 5 to 8 mm, along with a new 6 mm nodule. A soft tissue mass at the recto-sigmoid junction measuring 2.2 x 2.2 cm was also identified. Potential treatment options were discussed with the patient, including the fact that worsening findings on subsequent scans would preclude surgical management.The pulmonary and rectal lesions were identified again three months later. At this time, diffuse thickening of the psoas muscle at the level of the left renal bed and suspicious aortocaval and para-aortic lymph nodes were also noted. Colonoscopy identified a 7 cm mass approximately 7 cm from the anus consistent with leiomyosarcoma. Positron emission tomography (PET) scan identified diffuse disease, including the left psoas and pulmonary nodules, as well as cervical and para-aortic lymph nodes. It was unclear whether the lymph nodes and pulmonary nodules represented metastasis from an urothelial or mesenchymal tumour.The patient was averse to any kind of colostomy and would only consent to anterior resection of the tumour. The patient underwent laparascopic biopsy of a single retroperitoneal lymph node that identified metastatic urothelial carcinoma. The procedure was then converted to an open laparotomy and lo...