SEOM-GECP-GETTHI Clinical Guidelines for the treatment of patients with thymic epithelial tumours (2021)

Thymic epithelial tumours (TET) represent a heterogeneous group of rare malignancies that include thymomas and thymic carcinoma. Treatment of TET is based on the resectability of the tumour. If this is considered achievable upfront, surgical resection is the cornerstone of treatment. Platinum-based chemotherapy is the standard regimen for advanced TET. Due to the rarity of this disease, treatment decisions should be discussed in specific multidisciplinary tumour boards, and there are few prospective clinical studies with new strategies. However, several pathways involved in TET have been explored as potential targets for new therapies in previously treated patients, such as multi-tyrosine kinase inhibitors with antiangiogenic properties and immune checkpoint inhibitors (ICI). One third of patient with thymoma present an autoimmune disorders, increasing the risk of immune-related adverse events and autoimmune flares under ICIs. In these guidelines, we summarize the current evidence for the therapeutic approach in patients with TET and define levels of evidence for these decisions.MethodologyThese guidelines are based on leading studies published in peer review journals. The Infectious Diseases Society of America grading system was used to assign levels of evidence and grades of recommendation.

Salivary gland cancer in Southern Brazil: a prognostic study of 107 cases / Cáncer de glándula salival en el sur de Brasil: un estudio pronóstico de 107 casos

Background: Salivary gland cancers (SGC) represent an uncommon group of heterogeneous tumors. We per-formed a retrospective survey of SGC diagnosed in a reference center for treatment of malignant tumors from thesouth of Brazil aiming to determine the prognostic value of demographic, clinic and pathologic features.Material and Methods: Cases diagnosed as SGC between 2006 and 2016 were retrospectively collected. Medicalrecords were examined to extract demographic, clinic, pathologic and follow-up information.Results: One-hundred and seven cases of SGC were identified. The most common SGC were mucoepidermoidcarcinoma (MEC) (n = 39) followed by adenoid cystic carcinoma (AdCC) (n = 29). Among AdCCs, 55.2% of caseswere classified as cribriform, 27.6% as tubular and 17.2% as solid. The tubular subtype had the highest percentageof cases with perineural invasion (p=0.01). Among MEC, 61.5% of cases were classified as low grade, 15.4% asintermediate grade and 19.9% as high grade. Low grade MEC had the lowest percentage of cases with perineuralinvasion (p=0.04). The 5-year survival for loco-regional control, disease-free survival (DFS) and disease-specificsurvival were 75%, 70% and 84%, respectively. The following features were associated with poor DFS: advanced age (p=0.03), rural residency (p=0.01), being a smoker or former smoker (p=0.01), pain (p=0.03), nodal metastasis(p<0.001), need for chemotherapy (p=0.02), neck dissection (p=0.04), perineural invasion (p=0.01), and being diag-nosed with AdCC compared to MEC (p=0.02).Conclusions: The clinco-demographic and pathologic features identified as prognostic factors reveal the profile ofpatients at increased risk of recurrence and who would benefit from closer follow-up.(AU)

Resección quirúrgica de papilomatosis glandular endobronquial / Surgical Resection of Endobronchial Glandular Papilloma

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A histological evaluation of the surgical margins from human oral fibrous-epithelial lesions excised with CO2 laser, Diode laser, Er:YAG laser, Nd: YAG laser, electrosurgical scalpel and cold scalpel

Background: We aim to evaluate the presence of histological artefacts in the surgical margins of human oral fibro-epithelial hyperplasias excised with lasers of different wavelengths, and also electrosurgical scalpel and cold scalpel. Moreover, we aim to determine if some of these instruments could impair the normal histological diagnosis of these lesions. Material and Methods: We included 130 consecutive surgical samples of 80 females and 50 males (mean age of 53.82±16.55) with a histological diagnosis of an oral benign fibrous-epithelial hyperplasias. The samples were categorized into 6 groups according to the type of instrument used: CO2 laser group, diode laser group, Er:YAG laser group, Nd:YAG laser group, electrosurgical scalpel group and cold scalpel group. Histological instrument-induced changes were microscopic evaluated and related with clinical and pathological variables. Results: The instrument with highest tissue damage extension (TDE) was the electrosurgical scalpel (1002.2μm±434.92), followed by diode laser (913.73 μm±322.45), Nd:YAG (899.83μm±327.75), CO2 laser (538.37μm±170.50), Er:YAG laser (166.47μm±123.85), and at last with fewer alterations the cold scalpel group (2.36μm±7.27) (P < 0.001). The most regular incision was observed in CO2 laser group, followed by Er:YAG laser, Nd:YAG laser, electrosurgical scalpel and diode laser group with the less regular incision using cold scalpel as comparison (P < 0.001). A correlation was found between the incision score and TDE (P < 0.001). Regarding histological diagnosis, no case showed any limitation of diagnosis related with the use of any instrument evaluated. Conclusions: Our results suggest that lasers can be used for the excision of oral benign fibrous-epithelial hyperplasias, without hispathological diagnosis limitations, as long as the physical properties of each laser are known and respected. Er:YAG laser have shown to be a laser with few tissue damage extension and with good incision regularity, been a possible instrument of choice for the surgical removal of these lesions

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Etiología de la mastitis crónica: propuesta de secuencia diagnóstica / Proposed diagnosis sequence for chronic mastitis aetiology

Introducción: Las lesiones inflamatorias mamarias precisan con frecuencia de estudio histopatológico por su capacidad de imitar a los tumores mamarios malignos. El objetivo es proponer una secuencia diagnóstica de las inflamaciones mamarias benignas crónicas. Material y método: Se han revisado en la literatura los métodos y algoritmos diagnósticos de las mastitis crónicas. Resultados: Se propone un algoritmo diagnóstico para los procesos inflamatorios crónicos mamarios. Requiere determinar el patrón histopatológico inflamatorio y su localización, así como un estudio microbiológico apropiado. Posteriormente puede precisar de nuevas pruebas bioquímicas y serológicas orientadas por una correlación clinicopatológica para establecer un diagnóstico específico. Discusión: No se han identificado en la literatura otros algoritmos diagnósticos avalados por estudios de alto nivel de evidencia. Los patrones histopatológicos no son uniformes. Conclusiones: El diagnóstico etiológico precisa identificar patrones histopatológicos inflamatorios benignos y su localización, un estudio microbiológico y pruebas orientadas por correlación clinicopatológica. Se precisan estudios de investigación con niveles de evidencia altos

Introduction: Inflammatory breast lesions require histopathological study due to their ability to clinically and radiologically mimic malignant mammary tumours. The objective is to propose a diagnostic technique for benign chronic inflammatory processes of the breast. Material and methods: We reviewed the literature on the diagnostic methods used in chronic mastitis. Results: We propose a diagnostic algorithm for chronic inflammatory processes of the breast. The aetiological diagnosis requires identifying benign inflammatory histopathologic patterns and locations, and microbiological study. New biochemical and serological tests oriented by clinicopathological correlation may then be required to establish a specific diagnosis. Discussion: No diagnostic algorithms based on studies with a high level of evidence have been identified. No uniformity in histopathologic patterns has been described. Conclusions: The etiologic diagnosis requires identifying benign inflammatory histopathologic patterns and locations, microbiological study and tests oriented by clinicopathological correlation. There is a lack of studies with a high level of evidence

Carcinoma hepatocelular: presente y futuro / Hepatocellular carcinoma: Present and future

El carcinoma hepatocelular (CHC) es el sexto tumor más frecuente con más de 740.000 casos nuevos cada año y constituye la tercera causa de muerte por neoplasia, habiéndose descrito un aumento de su incidencia en los últimos años. Este tumor se desarrolla generalmente en pacientes con una enfermedad hepática crónica subyacente. En las 2 últimas décadas se ha producido un avance en su tratamiento: los pacientes de riesgo se incluyen en un programa de cribado, se ha desarrollado un sistema de estadificación pronóstica y finalmente han surgido nuevos tratamientos, sobre todo para aquellos pacientes con CHC avanzado. Este hecho ha motivado un mayor interés por este tumor y diversas sociedades científicas han elaborado guías de práctica clínica para el tratamiento de estos pacientes. En esta revisión presentamos una visión actual y futura de este tumor

Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide with over 740,000 new cases per year and the third leading cause of cancer-related death, with a growing incidence in recent years. This tumor usually arises in patients with an underlying chronic liver disease. The management of this tumor has improved over the past 2 decades: patients at risk are included in a surveillance program, a prognostic staging system has been created and, finally, new treatments particularly aimed at patients with advanced HCC have been developed. This fact has resulted in a greater interest in this tumor and several scientific societies have developed clinical practice guidelines for the management of patients with this disease. In this article, we review the current and future prospects of this tumor

Fatty thymic involution uptake mimicking a thymic epithelial tumour in a 18F-FDG PET/CT study / Captura de involución tímica grasa imitando un tumor epitelial tímico en un estudio 18F-FDG PET/TC

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Carcinoma adenoideo quístico primario de piel mamaria / Primary adenoid cystic carcinoma of the breast skin

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Hidroadenoma nodular / Nodular hidradenoma

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Comentario a «Metástasis cutáneas a distancia de cáncer de próstata: 2 casos» / Comment on «Distant cutaneous metastases of prostate cancer: a report of 2 cases»

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Nódulo de la hermana María José como primera manifestación de cáncer pancreático / Sister Mary Joseph’s nodule as initial pancreatic cancer manifestation

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Incidental diffuse esophageal intramural pseudodiverticulosis. A rare autopsy finding / Pseudodiverticulosis intramural difusa esofágica incidental. Un raro hallazgo de autopsia

Esophageal intramural pseudodiverticulosis (EIPD) is a rare condition of uncertain etiopathogenesis which usually presents with either intermittent or progressive dysphagia. A review of the literature revealed very few studies of its histopathology. We report the case of a 70-year-old diabetic man who died after a road traffic accident. The patient had no history of dysphagia. The entity was discovered incidentally during the medico-legal autopsy. The esophagus showed numerous dilated pseudodiverticula confined to the submucosa and lined by both stratified squamous and cuboidal epithelium. EIPD can remain stable and asymptomatic. This case demonstrates the importance of a thorough investigation during a forensic autopsy (AU)

La pseudodiverticulosis intramural esofágica (PDIE) es un raro proceso de etiopatogénesis incierta que generalmente se manifiesta con disfagia intermitente o progresiva. Una revisión de la literatura ha revelado muy pocos casos publicados mostrando el aspecto histológico de esta condición. Presentamos el caso de un varón de 70 años de edad, diabético, que falleció tras un accidente de tráfico. El paciente no tenía historia de disfagia. La entidad fue descubierta incidentalmente al practicar la autopsia médico-legal. El esófago mostraba numerosos pseudodivertículos confinados a la submucosa y tapizados por epitelio estratificado escamoso y cuboideo. La PDIE puede permanecer estable y asintomática. Este caso demuestra la importancia de una exhaustiva investigación en la autopsia forense (AU)

Recommendations in the management of epithelial appendiceal neoplasms and peritoneal dissemination from mucinous tumours (pseudomyxoma peritonei)

The epithelial appendiceal neoplasms are uncommon and are usually detected as an unexpected surgical finding. The general surgeon should be aware of the diversity of its clinical manifestations and biological behaviors along with the significance of the surgical treatment on the progression of the illness and the prognosis of the patients. The operative findings and, especially, tumor histology, determine the type of surgery. Intestinal histologic subtype behaves and should be treated similarly to the right colon neoplasms; while mucinous tumors, often discordant between histology and its aggressiveness, can be treated with a simple appendectomy or require complex oncological surgeries. Mucinous tumors are often associated with the presence of mucin or tumor implants in the abdominal cavity, being the clinical syndrome known as pseudomyxoma peritonei (PMP). PMP tends to present an indolent but deadly evolution and requires a multimodal approach as a single treatment with curative potential: complete cytoreductive surgery plus hyperthermic Intraperitoneal chemotherapy (CCRS ? HIPEC) now considered the standard of care in this pathology. The general surgeon should be aware of the governing principles of the treatment of appendiceal neoplasms with or without peritoneal dissemination, know the therapeutic frontiers in every situation (avoiding unnecessary or counterproductive surgeries) and sending early these patients to specialised centres in the radical management of malignant diseases of the peritoneum in the conditions and with the necessary information to facilitate a possible radical treatment (AU)

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Prognostic value of 18F-FDG PET/CT volumetric parameters in recurrent epithelial ovarian cancer / Valor pronóstico de los parámetros volumétricos de la 18F-FDG PET/TC en el cáncer epitelial de ovario recurrente

Objective. Metabolic tumour volume (MTV) and total lesion glycolysis (TLG) from 18F-FDG PET/CT are emerging prognostic biomarkers in various solid neoplasms. These volumetric parameters and the SUVmax have shown to be useful criteria for disease prognostication in preoperative and post-treatment epithelial ovarian cancer (EOC) patients. The purpose of this study was to evaluate the utility of 18F-FDG PET/CT measurements to predict survival in patients with recurrent EOC. Material and methods. Twenty-six patients with EOC who underwent a total of 31 18F-FDG PET/CT studies for suspected recurrence were retrospectively included. SUVmax and volumetric parameters whole-body MTV (wbMTV) and whole-body TLG (wbTLG) with a threshold of 40% and 50% of the SUVmax were obtained. Correlation between PET parameters and progression-free survival (PFS) and the survival analysis of prognostic factors were calculated. Results. Serous cancer was the most common histological subtype (76.9%). The median PFS was 12.5 months (range 10.7-20.6 months). Volumetric parameters showed moderate inverse correlation with PFS but there was no significant correlation in the case of SUVmax. The correlation was stronger for first recurrences. By Kaplan-Meier analysis and log-rank test, wbMTV 40%, wbMTV 50% and wbTLG 50% correlated with PFS. However, SUVmax and wbTLG 40% were not statistically significant predictors for PFS. Conclusion. Volumetric parameters wbMTV and wbTLG 50% measured by 18F-FDG PET/CT appear to be useful prognostic predictors of outcome and may provide valuable information to individualize treatment strategies in patients with recurrent EOC (AU)

Objetivo. El metabolic tumour volume (MTV) y la total lesion glycolysis (TLG) obtenidos de la 18F-FDG PET/TC son biomarcadores pronósticos emergentes en varias neoplasias. Estos parámetros volumétricos junto con el SUVmax son útiles para determinar el pronóstico preoperatorio y post-tratamiento de las pacientes con cáncer epitelial de ovario (CEO). El objetivo fue determinar la utilidad de los parámetros de la 18F-FDG PET/TC para predecir la supervivenvia de las pacientes con CEO recurrente. Material y métodos. Se incluyeron retrospectivamente 26 pacientes con CEO a las que se les realizó 31 estudios 18F-FDG PET/TC por sospecha de recidiva. Se obtuvo el valor del SUVmax, whole-body MTV (wbMTV) y whole-body TLG (wbTLG) con un umbral del 40% y 50% del SUVmax. Se estimó la correlación entre los parámetros PET y el intervalo libre de progresión (ILP) y se realizó análisis de supervivencia segun factores pronósticos. Resultados. El subtipo histológico más frecuente fue cáncer seroso (76,9%). La mediana del ILP fue 12,5 meses (rango 10,7-20,6 meses). Se observó correlación inversa moderada entre los parámetros volumétricos e ILP, sin evidenciar correlación significativa con SUVmax. La correlación fue más fuerte para primeras recidivas. Las curvas de supervivencia mostraron correlación entre wbMTV 40%, wbMTV 50% y wbTLG 50% con ILP. SUVmax y wbTLG 40% no fueron predictores de ILP de forma estadísticamente significativa. Conclusión. Los parámetros wbMTV y wbTLG 50% de la 18F-FDG PET/TC podrían utilizarse como factores pronósticos ofreciendo una valiosa información para individualizar el tratamiento de las pacientes con CEO recurrente (AU)

Cirugía citorreductora en cáncer epitelial de ovario en estadios avanzados / Cytoreductive surgery in advanced epithelial ovarian cancer

Objetivos: analizar los resultados quirúrgicos de citorreducción primaria y de intervalo en cáncer de ovario avanzado en el Hospital Universitario Puerta de Hierro Majadahonda. Material y métodos: las pacientes incluidas en el estudio fueron mujeres tratadas en nuestro centro de carcinoma epitelial de ovario en estadios III-IV entre 2009 y 2014. Resultados: un total de 39 pacientes fueron incluidas en el estudio. En el 41,03% de los casos se realizó cirugía de citorreducción primaria y en el 58,97% cirugía de intervalo. Se encontró afectación del espacio retrohepático en el 20,5% de los casos. La citorreducción completa se pudo realizar en el 82,1% de los casos. Conclusiones: en nuestro centro conseguimos cirugía de citorreducción completa en un alto porcentaje de casos debido a la colaboración de un equipo multidisciplinar, integrado por ginecólogos y cirujanos generales, capaces de abordar la enfermedad visible, tanto en el hemiabdomen inferior como en el superior (AU)

Objective: To analyze surgical results in primary and interval cytoreductive surgery in advanced ovarian cancer in the Puerta de Hierro Majadahonda University Hospital (Madrid, Spain). Material and methods: We included women with stage III-IV epithelial ovarian cancer who underwent surgery in our centre between 2009 and 2014. Results: A total of 39 patients were included in this study. Of these, 41.03% underwent primary cytoreductive surgery and 58.97% underwent interval surgery. We found retrohepatic evidence of tumour in 20.5% of the patients. Complete cytoreductive surgery was feasible in 82.1%. Conclusions: In our centre, a high percentage of complete cytoreductive surgery was achieved due to the cooperation of a multidisciplinary team composed of gynaecologists and gastrointestinal surgeons, able to deal with visible disease, in both the lower and upper abdomen (AU)

Hamartoma respiratorio epitelial adenomatoso bilateral de comportamiento atípico / Bilateral respiratory epithelial adenomatoid hamartoma with atypical behaviour

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Porocarcinoma: ¿infrecuente o infradiagnosticado? Estudio retrospectivo de 6 casos y revisión bibliográfica / Porocarcinoma: Uncommon or underdiagnosed? A retrospective study of 6 cases and a review of the literature

El porocarcinoma es un tumor maligno infrecuente, habitualmente originado sobre un poroma de larga evolución. Normalmente se localiza en extremidades inferiores, cabeza y cuello, en la sexta y séptima décadas de la vida. Debido a la escasa cantidad de casos documentados, realizamos un estudio retrospectivo durante 12 años consecutivos entre los diagnósticos registrados en la base de datos de nuestro Servicio de Anatomía Patológica. Recogimos 6 casos de dicho tumor sobre un total de unas 33.000 biopsias de piel, y analizamos sus características clínicas e histopatológicas. Observamos una incidencia 4 veces superior a la descrita en otros estudios, predominio en mujeres, y una media de edad y tamaño tumoral superiores. Su presentación clínica variada, larga evolución asintomática, y sus características arquitecturales, citológicas e inmunohistoquímicas, sí son concordantes con la literatura previa (AU)

Porocarcinoma is a rare malignant sweat gland tumour, usually developing from a long standing poroma. It is frequently found on the lower extremities or head and neck, and most cases occur in elderly patients. Due to the limited infrequency of documented cases, we performed a retrospective study over 12 consecutive years from the database of our department of pathology. We collected 6 cases of this tumour from a total of 33,000 skin biopsies and reviewed the main clinical and histopathological findings. In comparison to previous studies, we found a 4-times-higher incidence of porocarcinoma, female predominance, a higher average age and a larger tumour size. However, their diverse clinical presentation, longstanding asymptomatic evolution, morphological features and immunohistochemical profile are consistent with previous literature (AU)

Inclusiones glandulares benignas en ganglios centinelas de carcinoma de mama como causa de falsos positivos. Descripción de un caso y revisión de la literatura / Benign glandular inclusions in the sentinel nodes of breast cancer as a cause of false-positive diagnosis. A case report and literature review

Las inclusiones glandulares benignas de mama son entidades poco frecuentes y su presencia en el estudio intraoperatorio del ganglio centinela en la cirugía del cáncer de mama, puede dar lugar a diagnósticos erróneos que conllevan linfadenectomías innecesarias con su morbilidad asociada. Presentamos el caso clínico de una paciente con cáncer de mama, en cuya intervención se remitió un ganglio centinela que originó un diagnóstico falso positivo de metástasis y que ilustra la necesidad de conocer este proceso (AU)

Benign glandular inclusions are rare events. Their presence in the intraoperative evaluation of the sentinel lymph node in breast carcinoma surgery can result in diagnostic error and lead to an unnecessary axillary lymph node dissection with an increased risk of associated morbidity. We report the case of a woman with breast carcinoma. During surgery, evaluation of the sentinel node led to a false-positive diagnosis of metastasis. We discuss the diagnostic problem illustrated by this case, as well as the importance of avoiding overtreatment (AU)

Utilidad de la detección del virus del papiloma humano en el cribado de neoplasia intraepitelial anal en pacientes con conductas de riesgo / Usefulness of human papillomavirus testing in anal intraepithelial neoplasia screening in a risk behaviour population

INTRODUCCIÓN: La incidencia de la neoplasia intraepitelial anal está en aumento en determinados grupos con conductas de riesgo, y en su etiopatogenia está implicada la infección por el virus del papiloma humano (VPH). Dentro de los programas de cribado implementados en las últimas décadas se encuentra el uso sistemático de la citología anal y, más recientemente, la detección del VPH mediante captura de híbridos y genotipado. MATERIAL Y MÉTODO: Estudio de cohortes retrospectivo de la población con conductas de riesgo de desarrollar neoplasia intraepitelial anal atendida en la consulta de Infecciones de Transmisión Sexual del área de Dermatología del Hospital Costa del Sol desde enero de 2010 a diciembre de 2012, a la que se le realizó cribado de neoplasia intraepitelial anal mediante toma de citología anal y genotipado de VPH. RESULTADOS: El 50% de la población estudiada tenía infección por VIH. Se encontró una alta frecuencia de displasia anal y presencia de VPH en la citología (82,1%) y genotipado (79%). Se obtuvo una asociación estadísticamente significativa (p < 0,005) entre la presencia de genotipos de VPH de alto riesgo y la presencia de displasia de alto grado en la segunda citología dirigida. El genotipado de VPH permitió identificar 17 casos (22%) de displasia severa infradiagnosticados en la primera citología. CONCLUSIÓN: La citología anal a ciegas puede infradiagnosticar casos de displasia de alto grado. La detección de VPH puede complementar este procedimiento, permitiéndonos identificar aquellos pacientes con mayor riesgo de desarrollar displasia anal de alto grado

INTRODUCTION: The incidence of intraepithelial anal neoplasia is increasing in certain risk behaviour groups, and human papillomavirus (HPV) infection is involved in its pathogenesis. The systematic use of anal cytology, and more recently HPV detection by hybrid capture and genotyping, have been introduced into screening programs in recent decades. MATERIAL AND METHODS: A retrospective cohort study was carried out on individuals with risk behaviours of developing intraepithelial anal neoplasia and who attended Sexually Transmitted Infections clinics in the Dermatology area of the Hospital Costa del Sol from January 2010 to December 2012. The intraepithelial anal neoplasia screening was performed using anal cytology and HPV genotyping. RESULTS: Half (50%) of the study population were HIV positive. A high frequency of anal dysplasia and presence of HPV in cytology (82.1%) and genotype (79%) was found. A statistically significant association (P < .005) was obtained between the presence of high-risk HPV genotypes and the presence of high-grade dysplasia in the second directed cytology. HPV genotyping enabled 17 cases (22%) of severe dysplasia to be identified that were under-diagnosed in the first cytology. CONCLUSION: Cases of high-grade dysplasia can be under-diagnosed by a first anal cytology. Detection of HPV can supplement this procedure, leading to the identification of those patients most at risk of developing high-grade anal dysplasia

Cáncer de vejiga en hospitales públicos de Madrid / Bladder Cancer in public hospitals in Madrid

Con diseño retrospectivo se analizan 4.452 pacientes con cáncer de vejiga, procedentes del Registro de Tumores de Madrid. La serie ha sido seguida durante 15 años. Se estudian las variables que dicho registro posee. La edad media ha sido de 68,7 (DT 11,95). La razón de sexo ha sido de 5:1. Se ha encontrado la siguiente histología: N. Uroteliales 94,3%, N. Células escawmosas 3,2%, N. glandulares 0,9% y otras histologías 0,5%. La extensión tumoral más frecuente se ha correspondido con la localizada con un 83,5%, seguida de la regional con un 10,6%, la diseminada con un 4,9% y por último los "in situ" con un 0,7%. Los tratamientos han sido: Cirugía 37,8%; Cirugía más radioterapia 6,2%; Cirugía más Quimioterapia 38,4%; Cirugía más Inmunoterapia 6% y paliativos 2,7%. Se ha encontrado un 4% de tumores primarios múltiples. Este estudio ha permitido conocer la realidad del cáncer vesical en todas sus vertientes por proceder los pacientes del día a día de la misma población en la que se diagnosticaron a los enfermos

Retrospective design with 4,452 patients with bladder cancer from the Cancer Registry of Madrid are analyzed. The series has been followed for 15 years. Variables such registration has studied. The mean age was 68.7 (SD 11.95). The sex ratio was 5:1. We found the following histology: N. urothelial 94.3%, N. squamous cells 3.2%, N. glandular histologies 0.9% and other 0.5%. The most frequent tumor extension has corresponded with localized with 83.5%, followed by 10.6% with regional, disseminated with 4.9% and finally the "in situ" with 0.7 %. The treatments were: surgery 37.8%; surgery and radiotherapy 6.2%; surgery and chemotherapy 38.4%; immunotherapy and surgery 6% and palliative 2.7%. Found 4% of multiple primary tumors. This study has shown the reality of bladder cancer in all its aspects by patients come daily from the same population in which the patients were diagnosed