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Advances in cancer therapy have been substantial in terms of molecular understanding of disease mechanisms, however these advances have not translated into increased survival in the majority of cancer types. One unsolved problem in current cancer therapeutics is the substantial immune suppression seen in patients. Conventionally, investigations in this area have focused on antigennonspecific immune suppressive molecules such as cytokines and T cell apoptosis inducing molecules such as Fas ligand. More recently, studies have demonstrated nanovesicle particles termed exosomes are involved not only in stimulation but also inhibition of immunity in physiological conditions. Interestingly, exosomes secreted by cancer cells have been demonstrated to express tumor antigens, as well as immune suppressive molecules such as PD-1L and FasL. Concentrations of exosomes from plasma of cancer patients have been associated with spontaneous T cell apoptosis, which is associated in some situations with shortened survival. In this paper we place the "exosome-immune suppression" concept in perspective of other tumor immune evasion mechanisms. We conclude by discussing a novel therapeutic approach to cancer immune suppression by extracorporeal removal of exosomes using hollow fiber filtration technology. [ABSTRACT FROM AUTHOR]

The present study reports an unusual case of high-grade bladder cancer in a 10-year-old girl who complained of painless hematuria and urinary frequency. The tumor displayed sarcomatoid differentiation and an aggressive behavior, which required the administration of adjuvant chemotherapy. However, the disease progressed and the patient succumbed 6 months after surgery. It is known that the majority of malignant bladder cancers in pediatric patients are low-grade and present at an early stage, whereas sarcomatoid differentiation in the setting of a high-grade urothelial carcinoma is indicative of a poor prognosis. It is important that gross hematuria in pediatric patients is investigated carefully. It is recommended that the management of urothelial neoplasia in young patients should be predominantly decided on the basis of the grade and stage of the tumor rather than the age of the patient. [ABSTRACT FROM AUTHOR]

The present case report presents the case of exstrophy-epispadias complex (EEC) with the widest separation of the symphysis pubis to date. A 33-year-old male was referred to hospital with previously unreconstructed EEC malformation. The diagnosis established was of EEC with separation of the symphysis pubis and left inguinal hernia with adenocarcinoma of the bladder. The patient underwent radical cystectomy plus an ileal conduit and an expanded local lymphadenectomy. Osteotomy was not performed, and instead the defect of the pelvis and abdominal wall was repaired using meshes and a lower abdominal island skin flap. At 1 year after surgery the patient recovered well, with no indications of mesh distortion or major complications. [ABSTRACT FROM AUTHOR]