[Urachal adenocarcinoma of the bladder, our experience in 20 years]. / Adenocarcinoma de uraco, nuestra experiencia en 20 años.

OBJECTIVE: To report two cases of urachal adenocarcinoma and to review the published literature. METHODS / RESULTS: We present a review of our urachal carcinoma cases from a third level hospital between 1990-2011 in an area of 520.000 inhabitants. Both cases were middle aged men, consulting for repeated urine infections, and abdominal mass with hematuria and mucous discharge through the urethra. They were treated initially with partial cystectomy and adjuvant treatment with chemotherapy in one case, and chemo and radiotherapy in the other. The first case died in 3 years and the other is still alive after 4 years of follow up. CONCLUSIONS: Urachal adenocarcinomas of the bladder are rare tumors the natural history of which has not changed during the last years. Open partial cystectomy with en bloc resection of the bladder dome, urachus and the umbilicus is the standard treatment in localized stages, although minimal invasive techniques appear to have the same oncological outcomes. Pelvic lymphadenectomy is advised. Most of the patients are diagnosed at an advanced local or metastatic stage. There is a need to improve diagnostic techniques for early treatment and to find new chemotherapy protocols that can help to improve these patients' survival.

Prostate sarcoma: report of 2 cases and bibliographic review.

OBJECTIVE: To report two cases of prostate sarcoma and perform a review of the published literature. METHODS / RESULTS: The first case is a 21 year old patient who presented acute urine retention and lung metastases on diagnosis. He was diagnosed by TURP of rhabdomyosarcoma of the prostate dying 1 month after surgery. The second case was a 33 years old male who presented to the emergency room with anal pain, urinary symptoms, hematochezia and loss of 20 kg over the past 3 months. Abdominal CT scan showed an 11 x 10 x 9 cm mass in the lower pelvis that infiltrated the bladder and rectum, being unable to define its origin. CA 19.9, CEA and PSA were normal. The suspected diagnosis was a prostate sarcoma infiltrating rectum and bladder. A pelvic exenteration was performed with a wet colostomy. The pathologic diagnosis was a high grade sarcoma not clearly identified of the prostate. He was treated with adriamycin as adjuvant chemotherapy, having local recurrence, nodal involvement and multiple pulmonary metastases after 3 months of follow up CONCLUSIONS: Prostate sarcomas are rare tumors. This makes difficult to know their natural history. Their rapid progression and systemic spread, despite multimodal treatment, gives a mean survival of 24 months. Main survival factors are grade, a complete resection of the tumor and a low local stage. There is a need to find new chemotherapy protocols to increase survival rates as it has been shown in extremities sarcomas.

Signet-ring cell adenocarcinoma of the bladder: case series between 1990-2009.

OBJECTIVES: To present a revision on the signet-ring cell bladder adenocarcinomas found in our department. METHODS/RESULTS: We reviewed all the transurethral resections of the bladder (TURB) performed between 1990 and 2009 finding 9 cases of primary signet ring cell adenocarcinomas (4 pure and 5 mixed). Eight were male and one female, with ages between 39 and 82 years. Definitive treatment was radical cystectomy with Bricker's urinary diversion in four patients, cysctectomy with Mainz's II diversion in one patient and palliative management with TURB in three cases and percutaneous nephrostomy in the remaining case. We used adyuvant chemotherapy in three cases. Only two patients were alive at the time of the study. Mean survival was 327 days for pure tumors and 586 for the mixed ones. CONCLUSIONS: Signet-ring cell primary adenocarcinoma of the bladder is an uncommon type of tumor, with worse prognosis than transitional cell cancer. It is important to discard other possible metastatic origins(like stomach, prostate, lung, or ovary) because the management will be different. Radical cystectomy is the treatment of choice, with adyuvant chemotherapy if possible. Five year survival is less than 11%

Presentación testicular de un linfoma no Hodking tipo NK nasal y revisión de la literatura / Testicular presentation of a nasal type NK non Hodgkin lymphoma and review of the literature

Objetivos: Comunicar un caso de un tumor de células NK de tipo nasal originado en el testículo y realizar una revisión de la literatura publicada. Método/Resultado: Presentamos un paciente de 68 años de la edad, sin historia urológica previa, que acudió a nuestra consulta refiriendo desde hace 11 meses clínica de inflamación del teste derecho y afectación de la piel escrotal con mala respuesta a tratamiento antibiótico. Se realizó una orquiectomía por vía inguinal y se resecó la piel afectada. El diagnóstico histológico definitivo fue de linfoma no Hodgkin tipo NK nasal de células grandes. Posteriormente fue derivado al servicio de hematología que realizó un estudio de extensión confirmando con un frotis sanguíneo el diagnóstico de linfoma y tras estudiar al paciente se realizó un tratamiento sistémico con 3 ciclos de CHOP y profilaxis intratecal. Tras 20 meses de seguimiento desde el inicio de los síntomas el paciente no ha presentado afectación ganglionar o de algún otro órgano. Conclusiones: Los linfomas de células T/NK nasales son tumores poco frecuentes en nuestro medio siendo su presentación extra nasal toda una rareza y encontrado en la literatura revisada sólo 12 casos de esta presentación testicular. Es esencial el estudio anatomopatológico mediante inmunohistoquímica para clasificar dichos linfomas, ya que este tipo se caracteriza por una rápida diseminación sistémica y mala respuesta al tratamiento.

Objectives: To report a case of a nasal type NK cell tumor originated in the testicle and review the published literature. Method/Results: We report a 68 years old patient, without previous urological history, who came to our clinic referring clinical inflammation of the right testicle with scrotal skin involvement for eleven months, with poor response to antibiotic treatment. Inguinal orchiectomy was performed with resection of the affected skin. The definitive histologic diagnosis was nasal type NK large cell non-Hodgkin lymphoma. He was subsequently referred to Hematology which conducted an extension study and confirmed the lymphoma diagnosis with a blood smear. After staging, the patient underwent systemic treatment with 3 cycles of CHOP and intrathecal prophylaxis. After 20 months follow up from the onset of symptoms the patient has had no lymph node or other organ involvement. Conclusions: Nasal type T/NK cell lymphoma tumors are infrequent being extranasal presentation a rarity. We found only 12 cases of this testicular presentation in the literature. Pathological analysis using immunohistochemistry is essential to classify these lymphomas, as rapid systemic spread and poor response to treatment is characteristic is essential to classify these lymphomas, as rapid systemic spread and poor response to treatment is characteristic.

[Metastasis of colon adenocarcinoma to the epididymis and spermatic cord]. / Metástasis de adenocarcinoma de colon en epidídimo y cordón espermático.

OBJECTIVE: To report the case of an epididymal and spermatic cord metastasis of a colon adenocarcinoma. METHODS/RESULTS: We present the case of a 67 years old man, who presents several months after subtotal left colectomy for a left colon adenocarcinoma (pT3 NoMo), with a symptomatic right palpable testicular tumour. Right orchiectomy was done, demonstrating colon adenocarcinoma metastasis. CONCLUSIONS: Epididymal and spermatic cord metastases are very infrequent and they usually are found incidentally after prostate cancer orchyectomy.