[Primary signet ring cell bladder adenocarcinoma. Case report with a multidisciplinary therapeutical approach]. / Adenocarcinoma en células en anillo de sello primario de vejiga. Presentación de un caso clínico con tratamiento multidisciplinario.

INTRODUCTION: Bladder carcinoma is the second most frequent genitourinary tumor. Adenocarcinoma accounts for up to 0.5 to 2% of bladder carcinoma types. The pathology states the bladder adenocarcinomas are mucous secreting lesions with glandular, colloid or signet ring cell patterns. Even the important advances reached in the field of bladder carcinoma, yet less frequent lesions as bladder adenocarcinoma do not have a standarized treatment protocol. METHODS: Case report of a patient with primary signet ring cell bladder adenocarcinoma with a therapeutical multidisciplinary approach. Literature review. RESULTS: Patient's outcome and follow up, with regard of therapeutical implications based on pathological findings. CONCLUSIONS: Bladder adenocarcionoma is a rare oncological entity. Treatment protocols for these particular tumors are lacking. Multidisciplinary approach represents the best therapeutical intervention.

Further description of early clinically silent lupus nephritis.

Thirty silent lupus nephritis (SLN) patients were compared to 16 individuals bearing overt lupus nephritis (OLN). Results included: years of systemic lupus erythematosus (SLE) diagnosis were significantly earlier (4.6 +/- 2.8 years) in SLN than in OLN (7.18 +/- 3.61) (P < 0.05). Neurological compromise, hypertension, normocitic anemia and lymphopenia were significantly prevalent in OLN than in SLN (P < 0.05). Beside normal urinary sediment and renal function tests, the SLN group showed a moderate increase of both activity (AI) and chronicity (CI) renal pathology index when compared to highly increased AI and CI in OLN (P < 0.05). Seventy percent of SLN patients were ISN/RPS Classes I (6.6%) and II (63.3%) while 81% of OLN cases were Classes III, IV (37.5%) and V. IgG, IgA, IgM, lambda chain, C3 and fibrinogen immune deposits were found in 90% or over in both SLN and OLN individuals while in 60% or over, both groups also showed kappa chain, Clq and C4 deposits. While prevalence of ANA, anti-dsDNA and anti-C1q antibodies were similar in both groups, anti-histone, anti-RNP, CIC and CH50 serum levels were significantly different in OLN versus SLN (P < 0.05). We strongly suggest that indeed SLN is the earliest stage in the natural history of lupus nephritis.

Silent nephritis in systemic lupus erythematosus.

Silent lupus nephritis (SLN) was investigated in 42 renal asymptomatic patients and compared with 49 untreated patients with overt lupus nephropathy (OLN). Urinary sediment, quantitative proteinuria, creatinine clearance, antinuclear antibodies (ANA), complement, circulating immune complexes (CIC) and renal biopsies were evaluated in all of the patients. Forty-one out of the 42 (97.6%) patients had SLN according to histopathological findings. Results showed that the mean age, female/male ratio and the clinical activity index (SLEDAI) were similar in both groups (P > 0.05). The prevalence of ANA, anti-ds DNA, anti-ENA autoantibodies and C4 serum levels showed no statistical differences between the two groups (P > 0.05). Conversely, in the OLN group, elevated CIC and diminished CH50 and C3 serum levels were significantly different (P < 0.01). WHO class II was the predominant renal lesion in the group with SLN (P < 0.0001), whereas class IV was in the OLN patients (P < 0.0001). We conclude that, in our series, SLN was highly prevalent in renal asymptomatic patients with otherwise systemic lupus erythematosus. Furthermore, abnormal levels of CIC, CH50 and C3 associated with WHO class II suggest a moderate but ongoing activation of immune-mediated renal injury mechanisms.

Riñón trasplantado: aspectos históricos, inmunológicos e histopatológicos / Renal transplantation: histopathology and immunological history aspects

El trasplante renal es el tratamiento sustitutivo de elección en todo el mundo, para pacientes con insuficiencia renal crónica terminal. Históricamente sus comienzos se sitúan a principios del siglo XX en Europa. Su éxito y permanencia como tratamiento electivo hasta ahora es la consecuencia principalmente de los adelantos de las técnicas quirúrgicas, del conocimiento de los fenómenos inmunológicos que se relacionan con la colocación de injertos y del descubrimiento de nuevas drogas inmunosupresoras, ya de uso corriente, como lo es la Ciclosporina A, que tiene gran efectividad en controlar los fenómenos de rechazo. La mejoría en la supervivencia de los injertos ha motivado también el desarrollo de una activa clínica de trasplante renal para encarar las alteraciones del funcionamiento de los injertos, cuyo diagnóstico definitivo descansa en el estudio morfológico de la biopsia renal, que se considera el estándar de oro y cuyos hallazgos histopatológicos fundamentales se muestran en la presente revisión

Ductal cell carcinoma of the kidney with extensive signet ring cell mucosecreting areas. A case report with immunohistochemical analysis.

We present the case of a 45-year-old patient with a renal ductal cell carcinoma arising in the Bellini ducts that was composed of histologically well-differentiated tubulopapillary and cystic areas with desmoplastic stroma, extensive mucosecreting areas, and regions depicting a transition between these two constituents. The mucosecreting component was mostly formed by signet ring tumor cells containing cytoplasmic Alcian blue-PAS-stainable mucins. The tubulopapillary and cystic areas of the tumor showed the immunohistochemical staining for low and high molecular weight cytokeratin, EMA, vimentin and Ulex europaeus, characteristic of ductal cell carcinoma. The mucosecreting cells also presented intense positive staining for cytokeratin and vimentin, and this is quite similar to observations reported in some forms of gastrointestinal cancer with rhabdoid features that are indicative of poor prognosis. Our findings suggest that mucosecreting areas with signet ring cells represent an extreme metaplastic change that can seldom occur in certain forms of renal tumors.