Denosumab in men receiving androgen-deprivation therapy for prostate cancer.

BACKGROUND: Androgen-deprivation therapy is well-established for treating prostate cancer but is associated with bone loss and an increased risk of fracture. We investigated the effects of denosumab, a fully human monoclonal antibody against receptor activator of nuclear factor-kappaB ligand, on bone mineral density and fractures in men receiving androgen-deprivation therapy for nonmetastatic prostate cancer. METHODS: In this double-blind, multicenter study, we randomly assigned patients to receive denosumab at a dose of 60 mg subcutaneously every 6 months or placebo (734 patients in each group). The primary end point was percent change in bone mineral density at the lumbar spine at 24 months. Key secondary end points included percent change in bone mineral densities at the femoral neck and total hip at 24 months and at all three sites at 36 months, as well as incidence of new vertebral fractures. RESULTS: At 24 months, bone mineral density of the lumbar spine had increased by 5.6% in the denosumab group as compared with a loss of 1.0% in the placebo group (P<0.001); significant differences between the two groups were seen at as early as 1 month and sustained through 36 months. Denosumab therapy was also associated with significant increases in bone mineral density at the total hip, femoral neck, and distal third of the radius at all time points. Patients who received denosumab had a decreased incidence of new vertebral fractures at 36 months (1.5%, vs. 3.9% with placebo) (relative risk, 0.38; 95% confidence interval, 0.19 to 0.78; P=0.006). Rates of adverse events were similar between the two groups. CONCLUSIONS: Denosumab was associated with increased bone mineral density at all sites and a reduction in the incidence of new vertebral fractures among men receiving androgen-deprivation therapy for nonmetastatic prostate cancer. (ClinicalTrials.gov number, NCT00089674.)

Outcomes in Renal Cell Carcinoma with Inferior Vena Cava Thrombus Treated with Surgery.

INTRODUCTION: Renal cell carcinoma can invade through the renal vein into the inferior vena cava, and can extend intraluminally, with tumor-thrombus formation. METHODS: Retrospective study from January 2003 to August 2016. Surgical outcomes were analyzed. Neves classification was used for patient categorization. Kaplan Meier and Log-Rank test were used for survival analysis. RESULTS: A total of 134 patients were included, 69 males (51.4%) and 65 females (49%), M:F ratio 1.06:1. Tumor size, bleeding and surgical time were higher in level IV thrombi (mean 16.1cm, 3 064ml and 6.5hrs, respectively), compared to level I (8.5cm, 1033ml and 3.1hrs, respectively). A higher frequency of positive lymph nodes was observed in levels III and IV compared with levels I and II (49% vs. 17.7%, p=0.0001). Distant metastases were observed in 36 pts. (27%). Overall surgical mortality was 4.5%. 5-year overall survival was 63%. We observed a 5-year survival in patients with level I-II 82% and level III and IV 46%. CONCLUSIONS: Our results suggest the benefit for the patient of an aggressive surgical approach with an acceptable mortality and 5-year survival rate. The results obtained justify an aggressive surgical approach to these tumors.

History of gonorrhea and prostate cancer in a population-based case-control study in Mexico.

UNLABELLED: We evaluated the association between a history of sexually transmitted diseases (STDs) and the risk for prostate cancer (PC) among Mexican males. METHODS: PC incident cases (n=402) that were identified at six public hospitals in Mexico City were matched by age (±5 years) with 805 population controls with no history of PC. By face-to-face interview, we obtained information about sexual history, previous STDs, sociodemographic characteristics, and familial history of PC. An unconditional logistic regression model was used to estimate the risk for PC. RESULTS: A total of 16.6% of men reported having had at least one previous STD, and the most frequently reported STD was gonorrhea (10.5%). After adjusting by PC familial history, the history of STD was associated with a two-fold greater risk of PC: odds ratio (OR)=2.67; 95% confidence interval (95% CI=1.91-3.73). When each STD was evaluated separately, only gonorrhea was associated with a significant increase in PC risk (OR=3.04; 95% CI=1.99-4.64). These associations were similar when we stratified by low-risk PC (Gleason <7) and high-risk PC (Gleason ≥7). CONCLUSION: These results confirm that STDs, and particularly gonorrhea, may play an etiological role in PC among Mexican males, which is consistent with a previous report from a multiethnic cohort.

Clinicopathologic analysis of choriocarcinoma as a pure or predominant component of germ cell tumor of the testis.

Although well recognized in the literature, the contemporary clinicopathologic data regarding choriocarcinoma (CC) as a pure or the predominant component of a testicular germ cell tumor (GCT) are limited. Herein, we present a series of pure CC and predominant CC in mixed GCT of the testis obtained from a single oncology institution. A comprehensive histologic review of 1010 orchiectomies from 1999 to 2011 yielded 6 (0.6%) pure CC and 9 (0.9%) mixed GCT cases with a predominant CC component. Patients' ages ranged from 20 to 39 years (median 29 y). All patients had markedly elevated serum ß-hCG levels (median 199,000 IU/mL) at presentation. All tumors were unilateral and involved the right (9/15) and left (6/15) testis. The mean tumor size was 6.5 cm (range, 1.5 to 8 cm). Histology was similar for pure CCs and the CC component of mixed GCTs. CC commonly showed expansile hemorrhagic nodular cysts surrounded by variable layers of neoplastic trophoblastic cells (mononucleated trophoblasts and syncytiotrophoblasts). The syncytiotrophoblasts usually covered columns of mononucleated trophoblasts and occasionally formed plexiform aggregates and pseudovillous protrusions. Immunohistochemical stains suggested a mixture of cytotrophoblasts (p63+, HPL_) and intermediate trophoblasts (p63-, HPL weak +/-) in the columns of mononucleated cells. In the 9 mixed GCTs, CC comprised 50% to 95% (7/9 were ≥80% CC) of the tumor; 7 were combined with 1, and 2 were combined with 2 other GCT components. The non-CC components included teratoma (5/9), seminoma (2/9), yolk sac tumor (2/9), and embryonal carcinoma (2/9). Lymphovascular invasion, spermatic cord invasion, and tunica vaginalis invasion were present in 15/15, 5/15, and 1/12 cases, respectively. In mixed GCTs, these locally aggressive features were attributed to the CC component, except in 1 tumor in which it was also exhibited by the embryonal carcinoma component. Lymphovascular invasion was multifocal to widespread in 73% of tumors. The stages of the 15 tumors were: pT2 (10), pT3 (5); NX (1), N1 (4), N2 (5), N3 (5); and M1a (2) and M1b (13). Distant organ metastasis mostly involved the lungs (11) and liver (10). Follow-up information was available in 14 patients, all of whom received cisplatin-based chemotherapy. All 6 pure CC patients were dead of disease (range, 6 to 14 mo, median 9.5 mo). Follow-up of 8 patients with predominant CC (range, 10 to 72 mo, median 27 mo) showed that 5 died of the disease, and 1 was alive with disease and 2 were alive with no evidence of disease at 60 and 72 months of follow-up, respectively; these latter 2 patients were the only ones with M1a disease on presentation. This series confirms the proclivity for high-stage presentation including presence of distant metastasis, hematogenous spread, and poor outcome of testicular CC. Mixed GCT with a predominant CC component has similar tendency for high-stage presentation, marked elevation of serum ß-hCG levels, and aggressive behavior compared with pure CC. This study also showed that distant metastasis by CC when only involving the lungs (M1a) may not be uniformly fatal with chemotherapy. The mononucleated trophoblastic columns in testicular CC appear to be a mixture of cytotrophoblasts and intermediate trophoblasts, similar to that described in gestational CC.

The variable morphological spectrum of penile basaloid carcinomas: differential diagnosis, prognostic factors and outcome report in 27 cases classified as classic and mixed variants

Background: Basaloid carcinomas of the penis, HPV-related tumors, are morphologically less homogenous than originally thought. The study objective was to evaluate the prognostic influence of the basaloid pattern in mixed tumors. Methods: We studied 154 Mexican patients from the Hospital de Oncología, CMN, Mexico City (2000­2013) and found 27 with basaloid features in at least 20% of the sections classified as classic basaloid (8 cases), warty-basaloid (7), papillary-basaloid (5) and usual-basaloid squamous cell carcinomas (7). We evaluated patients' age, site and size of tumor, histological classification, grade, thickness, anatomical level, vascular and perineural invasion, prognostic index score and node involvement. Penile intraepithelial neoplasia in adjacent epithelia was documented. Follow up ranged from 12­78 months. Statistical methods were Fisher's exact test and Kruskal-Wallis test. Kaplan-Meier method and log-rank test were used for survival analysis. The cutoff for statistical significance was p <0.05. Results: There were not clinical differences. Microscopically types were distinctive and easy to separate. Usual-basaloid squamous cell carcinomas were smaller, thinner and rarely invaded corpora cavernosa, with a low prognostic index score. Classic basaloid, warty-basaloid and papillary-basaloid carcinomas had higher rates of vascular and perineural invasion and higher prognostic index scores. These findings correlated with the rate of nodal metastasis. The majority of patients with classic and papillary-basaloid neoplasms died from systemic metastasis (87.5 and 80%) whereas only 1 patient with usual-basaloid carcinoma died of the disease (14%). Conclusions: Basaloid carcinomas are not a single entity but a spectrum of variable histological architectures mixed with those of classic basaloid tumors. Identification of mature squamous cells in a basaloid carcinoma may be important to recognize and report because patients with these tumors may carry a better prognosis (AU)

Leiomyosarcoma of the kidney: case report.

BACKGROUND: Renal sarcomas represent 1-2% of malignant kidney tumors in adults; 50% of renal sarcomas are composed of leiomyosarcomas. These tumors generally arise from the renal capsule, smooth muscle tissue of the renal pelvis and intrarenal vessels. They are indistinguishable from other renal masses prior to surgery and are associated with an adverse prognosis. CLINICAL CASE: We report the case of a 58-year-old female with a clinical course characterized by asthenia, weakness, generalized attack to her health status and pain in the left renal fossa. Computed axial tomography was performed where a left retroperitoneal tumor was diagnosed. Left radical nephrectomy was performed. The histopathology report demonstrated leiomyosarcoma originating from the renal sinus vessels. The patient was successfully treated with adjuvant radiotherapy. CONCLUSIONS: Renal leiomyosarcomas usually have an aggressive biological behavior with poor prognosis, accounting for surgical treatment with wide resection associated with adjuvant chemotherapy and radiotherapy as the only therapeutic option.

Management of bladder cancer with Studer orthotopic neobladder: 13-year experience.

BACKGROUND: We present the results of patients submitted to a Studer type urinary orthotopic derivation after radical cystectomy. METHODS: The files of patients with bladder cancer submitted to a radical cystectomy plus the procedure of the ileal neobladder were reviewed in our hospital from January 1992 until December 2004. Patients were divided into two groups: group A--60 years old or younger and group B-->60 years old. RESULTS: From 306 patients submitted to radical cystectomy with urinary derivation, there were 42 patients (13.7%) included with Studer type neobladder. There were 34 (80.9 %) men and 8 (19.1%) women, with an average age of 60 years. Average surgical time was 7 h with an average blood loss of 1600 cc requiring transfer to intensive care unit (ICU) in 55% of the cases. The most frequent early complication was metabolic acidosis that was present in 28 (66%) patients. The most severe complication was ileal-ureter urinary leak, which was present in seven (16.6 %) patients. Among the most frequent late complications are the day- and night-time urinary incontinence often related to urinary infections and intestinal occlusion. Overall 5-year survival was 71%, cancer-specific mortality was 15% and surgical-related mortality was 7.3%. CONCLUSIONS: The performance of procedures with orthotopic neobladders is actually feasible in experienced hospital centers and is a valuable alternative to urinary heterotopic derivation with ileal conduit. Postoperative patient management and regular follow-up is of major importance.

[Surgical experience with urachal carcinoma]. / Experiencia quirúrgica en el adenocarcinoma de uraco.

BACKGROUND: Urachal carcinomas are rare neoplasms that constitute <1% of bladder tumors. We undertook this study to describe the medical and surgical experience of urachal carcinomas treated in our hospital. METHODS: We carried out a retrospective, descriptive and observational study. Clinical files were reviewed of patients with diagnosis of bladder cancer and who were operated on with radical cystectomy with urinary substitution and extended partial cystectomy, selecting those patients with pathological report of urachal carcinoma. The study was conducted from January 1994 to May 2007 analyzing the following data: age, sex, symptoms, diagnostic methods, surgical approach, complications and disease-free survival. RESULTS: Of the 306 patients operated on with radical surgery for bladder cancer, only five patients (1.6%) had a diagnosis of urachal carcinoma. There were three (60%) men and two (40%) women, with a median age of 61 years. Hematuria was the chief complaint in all cases and the reason why they were initially treated with ultrasonography (USG). In one case, tumor of the right ovary was documented and the patient underwent exploratory laparotomy and extended partial cystectomy. In the other four cases, tumor was reported in the dome of the bladder and for this reason cystoscopy and transurethral resection of the bladder (TURB) were done, confirming the clinical findings in addition to the pathology report suggesting urachal carcinoma. Computed tomography (CT) confirmed the tumor in urachal topography, reporting a Sheldon clinical stage IIIb in three patients and stage IVa in one patient. This was the reason for the Studer-type orthotopic bladder substitution. Currently, four patients are being followed-up without recurrence, reporting only one death related to the disease. CONCLUSIONS: Urachal carcinomas are rare tumors with an incidence of 1.6% in our studied population. Symptoms in most cases are similar to those of bladder pathology origin. The surgical approach and procedure described here provide the best opportunity for disease-free survival.

[Androgen-deprivation therapy in the management of neuroendocrine prostate cancer].

BACKGROUND: Prostatic neuroendocrine carcinomas comprise <1% of all prostate neoplasms, and approximately 200 cases have been reported in the literature. We undertook this study to describe the experience in the management of prostatic neuroendocrine carcinoma with androgen-deprivation therapy (ADT). METHODS: We designed a retrospective, descriptive and observational study. In patients with suspicion of prostate cancer, transrectal ultrasonography-guided biopsy (TRUS) or transurethral resection of prostate (TURP) was carried out during the period from January 2000 to December 2007. Patients were selected by anatomopathological diagnostic study of neuroendocrine carcinoma including pure and mixed variants. Characteristics analyzed were age, clinical stage, prostate-specific antigen (PSA), imaging studies, treatment and survival. RESULTS: Ten cases were included with a median age of 66.5 years. Symptoms at diagnosis were associated with metastasis to other organs, one with bone metastasis, and presenting pain in 100% of the cases. A suspicious rectal digital examination was detected in 100% of the patients. In three (30%) patients, PSA was suspicious for prostate cancer. The extension studies showed bone, locoregional, lung and hepatic metastases. In six (60%) patients mixed variant was documented (acinar adenocarcinoma and neuroendocrine carcinoma) with a median survival of 11.6 months. In four patients (40%), pure neuroendocrine carcinoma was documented with a median survival of 7 months. CONCLUSIONS: Prostatic neuroendocrine carcinoma is uncommon, aggressive and represents a prostatic neoplasia without PSA expression. In advanced disease, very low response is reached with ADT.

[Renal tumor in a pelvic kidney. Case report]. / Tumor renal en riñón ectópico pelvico presentación de un caso.

OBJECTIVE: An uncommon association of renal cell carcinoma in a pelvic kidney is described, the literature is reviewed. METHODS: A case of renal cell carcinoma in a pelvic kidney is presented, and the literature briefly reviewed, with special reference to six cases reported. RESULTS: Renal cell carcinoma in a pelvic kidney is uncommon, the paucity of previous reports of this association is surprising. Besides renal cell carcinoma is the most common malignant renal tumour in the adult and renal ectopy is relatively common more cases of this association would be expected. CONCLUSIONS: Renal cell carcinoma is the most common malignant renal tumour in the adult and renal ectopy is relatively common, the actual incidence among autopsy series is 1 in 900, it has been an uncommon association, with only six cases reported. The surgical approach to ectopic kidneys merits caution because of the uncertain vascular anatomy, and vascular studies may be indicated to avoid complications, the present case is important because it represent the most common urological cancers at our institution with an unusual presentation.

Trece años de experiencia en el manejo de cáncer vesical con neovejiga ortotópica de Studer / Management of bladder cancer with Studer orthotopic neobladder: 13-year experience

Introducción: Posterior a la cistectomía radical, la derivaciones urinarias ortotópicas han tomado importancia en los últimos años. El objetivo de este informe es presentar los resultados en pacientes sometidos a derivación urinaria ortotópica tipo Studer posterior a cistectomía radical. Material y métodos: Se revisaron expedientes de pacientes con cáncer vesical sometidos a cistectomía radical más realización de neovejiga ileal entre enero de 1992 y diciembre de 2004. Resultados: De los 306 pacientes operados de cistectomía radial con derivación urinaria, se incluyeron 42 (13.7 %) pacientes en quienes la derivación urinaria fue neovejiga tipo Studer, 34 (80.9 %) hombres y ocho (19.1 %) mujeres, con una edad promedio de 60 años. El tiempo quirúrgico promedio fue de siete horas, con sangrado promedio de 1600 ml, requiriendo ingreso a unidad de terapia intensiva 55 % de los casos. La complicación temprana más frecuente fue la acidosis metabólica, presente en 28 (66 %) pacientes, y la más grave fue la fuga urinaria uretero-ileal, en siete (16.6 %). Entre las complicaciones tardías más importantes destacan la incontinencia urinaria diurna y nocturna, frecuentemente relacionadas a infecciones de vías urinarias y oclusión intestinal. A cinco años de seguimiento, la sobrevida global fue de 71 %, la mortalidad específica por cáncer fue de 15 % y la mortalidad relacionada a la cirugía de 7.3 %. Conclusiones: La realización de neovejigas ortotópicas es reproducible en centros con experiencia y una alternativa a la derivación urinaria heterotópica con conducto ileal.

BACKGROUND: We present the results of patients submitted to a Studer type urinary orthotopic derivation after radical cystectomy. METHODS: The files of patients with bladder cancer submitted to a radical cystectomy plus the procedure of the ileal neobladder were reviewed in our hospital from January 1992 until December 2004. Patients were divided into two groups: group A--60 years old or younger and group B-->60 years old. RESULTS: From 306 patients submitted to radical cystectomy with urinary derivation, there were 42 patients (13.7%) included with Studer type neobladder. There were 34 (80.9 %) men and 8 (19.1%) women, with an average age of 60 years. Average surgical time was 7 h with an average blood loss of 1600 cc requiring transfer to intensive care unit (ICU) in 55% of the cases. The most frequent early complication was metabolic acidosis that was present in 28 (66%) patients. The most severe complication was ileal-ureter urinary leak, which was present in seven (16.6 %) patients. Among the most frequent late complications are the day- and night-time urinary incontinence often related to urinary infections and intestinal occlusion. Overall 5-year survival was 71%, cancer-specific mortality was 15% and surgical-related mortality was 7.3%. CONCLUSIONS: The performance of procedures with orthotopic neobladders is actually feasible in experienced hospital centers and is a valuable alternative to urinary heterotopic derivation with ileal conduit. Postoperative patient management and regular follow-up is of major importance.

Experiencia quirúrgica en el adenocarcinoma de uraco / Surgical experience with urachal carcinoma

Introducción: Los adenocarcinomas de uraco constituyen menos de 1 % de las neoplasias malignas vesicales. El objetivo de esta investigación fue describir la experiencia médica y quirúrgica al respecto en nuestro centro hospitalario. Material y métodos: Estudio retrospectivo, descriptivo y observacional de pacientes con diagnóstico de cáncer vesical a quienes se les efectuó cistectomía radical con derivación urinaria o cistectomía parcial, seleccionando aquellos con informe patológico de adenocarcinoma de uraco entre enero de 1994 y mayo de 2007. Se analizó edad, sexo, sintomatología, métodos diagnósticos, abordaje quirúrgico, complicaciones y sobrevida. Resultados: De 306 pacientes, cinco (1.6 %) tuvieron adenocarcinoma del uraco: tres hombres (60 %) y dos mujeres (40 %), con edad promedio de 61 años. Dado que la hematuria constituyó el síntoma común, fueron abordados inicialmente con ultrasonido. En uno se documentó tumor de ovario derecho, por lo que se realizó laparotomía exploradora y cistectomía parcial en bloque. En cuatro se identificó tumor en domo vesical y se efectuó cistoscopia y resección transuretral vesical; el informe de patología sugirió adenocarcinoma de uraco y la tomografía axial computarizada lo confirmó, permitiendo la etapificación clínica IIIb de Sheldon en tres pacientes y IVa en uno. Se realizó cistectomía radical con neovejiga ortotópica tipo Studer. Cuatro pacientes se encuentran sin recurrencia y uno murió a consecuencia de la enfermedad. Conclusiones. Los adenocarcinomas de uraco tuvieron una incidencia de 1.6 % en la población estudiada. La sintomatología refleja en la mayoría de los casos patología vesical, por lo que son estudiados y abordados como tal. La cirugía es la mejor oportunidad de cura.

BACKGROUND: Urachal carcinomas are rare neoplasms that constitute <1% of bladder tumors. We undertook this study to describe the medical and surgical experience of urachal carcinomas treated in our hospital. METHODS: We carried out a retrospective, descriptive and observational study. Clinical files were reviewed of patients with diagnosis of bladder cancer and who were operated on with radical cystectomy with urinary substitution and extended partial cystectomy, selecting those patients with pathological report of urachal carcinoma. The study was conducted from January 1994 to May 2007 analyzing the following data: age, sex, symptoms, diagnostic methods, surgical approach, complications and disease-free survival. RESULTS: Of the 306 patients operated on with radical surgery for bladder cancer, only five patients (1.6%) had a diagnosis of urachal carcinoma. There were three (60%) men and two (40%) women, with a median age of 61 years. Hematuria was the chief complaint in all cases and the reason why they were initially treated with ultrasonography (USG). In one case, tumor of the right ovary was documented and the patient underwent exploratory laparotomy and extended partial cystectomy. In the other four cases, tumor was reported in the dome of the bladder and for this reason cystoscopy and transurethral resection of the bladder (TURB) were done, confirming the clinical findings in addition to the pathology report suggesting urachal carcinoma. Computed tomography (CT) confirmed the tumor in urachal topography, reporting a Sheldon clinical stage IIIb in three patients and stage IVa in one patient. This was the reason for the Studer-type orthotopic bladder substitution. Currently, four patients are being followed-up without recurrence, reporting only one death related to the disease. CONCLUSIONS: Urachal carcinomas are rare tumors with an incidence of 1.6% in our studied population. Symptoms in most cases are similar to those of bladder pathology origin. The surgical approach and procedure described here provide the best opportunity for disease-free survival.

Bloqueo androgénico total en el manejo del cáncer de próstata neuroendocrino / Androgen-deprivation therapy in the management of neuroendocrine prostate cancer

Introducción: El carcinoma prostático neuroendocrino constituye menos de 1 % de las neoplasias prostáticas, con menos de 200 casos en la literatura. El objetivo de esta investigación fue describir la experiencia en el manejo del carcinoma neuroendocrino de próstata con bloqueo androgénico total. Material y métodos: Estudio retrospectivo, descriptivo y observacional, en el que se revisaron los expedientes de pacientes con sospecha de cáncer de próstata sometidos a biopsia transrectal o resección transuretral de próstata, de enero de 2000 a diciembre de 2007. Fueron seleccionados pacientes con diagnóstico anatomopatológico de carcinoma neuroendocrino en sus variantes pura y mixta. Se analizó edad, estadio clínico, antígeno prostático específico, estudios de gabinete, tratamiento y sobrevida. Resultados: Se incluyeron 10 casos con edad media de 66.5 años; los síntomas al momento del diagnóstico estaban asociados a invasión metastásica a distancia, siendo el principal el dolor óseo. Se identificó un tacto sospechoso en todos los pacientes y solo en tres (30 %) el antígeno prostático específico fue sospechoso de cáncer. Los estudios de extensión determinaron actividad metastásica ósea, locorregional, pulmonar y hepática. En seis (60 %) se documentó la variante mixta (adenocarcinoma acinar más carcinoma neuroendocrino), con una sobrevida promedio de 11.6 meses, y en cuatro (40 %) se registró carcinoma neuroendocrino puro, con una sobrevida promedio de siete meses. Conclusiones: El carcinoma neuroendocrino de próstata es infrecuente, agresivo y un ejemplo de neoplasia prostática que no expresa el antígeno prostático específico, con mala respuesta al bloqueo androgénico total en etapa avanzada.

BACKGROUND: Prostatic neuroendocrine carcinomas comprise <1% of all prostate neoplasms, and approximately 200 cases have been reported in the literature. We undertook this study to describe the experience in the management of prostatic neuroendocrine carcinoma with androgen-deprivation therapy (ADT). METHODS: We designed a retrospective, descriptive and observational study. In patients with suspicion of prostate cancer, transrectal ultrasonography-guided biopsy (TRUS) or transurethral resection of prostate (TURP) was carried out during the period from January 2000 to December 2007. Patients were selected by anatomopathological diagnostic study of neuroendocrine carcinoma including pure and mixed variants. Characteristics analyzed were age, clinical stage, prostate-specific antigen (PSA), imaging studies, treatment and survival. RESULTS: Ten cases were included with a median age of 66.5 years. Symptoms at diagnosis were associated with metastasis to other organs, one with bone metastasis, and presenting pain in 100% of the cases. A suspicious rectal digital examination was detected in 100% of the patients. In three (30%) patients, PSA was suspicious for prostate cancer. The extension studies showed bone, locoregional, lung and hepatic metastases. In six (60%) patients mixed variant was documented (acinar adenocarcinoma and neuroendocrine carcinoma) with a median survival of 11.6 months. In four patients (40%), pure neuroendocrine carcinoma was documented with a median survival of 7 months. CONCLUSIONS: Prostatic neuroendocrine carcinoma is uncommon, aggressive and represents a prostatic neoplasia without PSA expression. In advanced disease, very low response is reached with ADT.

Tumor renal en el riñón ectópico pélvico. Presentación de un caso / No disponible

OBJETIVOS: Presentar un caso de carcinoma de células renales en un riñón ectópico pélvico, siendo esta una asociación poco frecuente. Revisamos la literatura existente. METODO: Se presenta un caso clínico de un tumor renal en un riñón ectópico pélvico y revisamos literatura, revisan- do los 6 casos publicados en la literatura (3, 5, 7, 8, 9). RESULTADOS: El carcinoma de células renales en un riñón ectópico pélvico es infrecuente, siendo la escasez de reportes previos sorprendente, ya que el carcinoma de células renales es el tumor renal más común en el adulto y la ectopia renal es relativamente frecuente, más casos con esta asociación se esperarían (8). CONCLUSIONES: El carcinoma de células renales es el tumor renal mas común en los adultos y la ectopia renal se presenta actualmente con una incidencia de 1 en 900 autopsias (8), siendo esta una asociación rara, habiendo solo 6 casos reportados en la literatura. Su abordaje quirúrgico debe ser con cautela ya que la anatomía vascular es incierta y se deben realizar los estudios preoperatorios necesarios para evitar complicaciones, el presente caso es importante ya que representa el tumor urológico mas frecuente en nuestro centro con una presentación inusual (AU)

OBJECTIVE: An uncommon association of renal cell carcinoma in a pelvic kidney is described, the literature is reviewed. METHODS: A case of renal cell carcinoma in a pelvic kidney is presented, and the literature briefly reviewed, with special reference to six cases reported. RESULTS: Renal cell carcinoma in a pelvic kidney is uncommon, the paucity of previous reports of this association is surprising. Besides renal cell carcinoma is the most common malignant renal tumour in the adult and renal ectopy is relatively common more cases of this association would be expected. CONCLUSIONS: Renal cell carcinoma is the most common malignant renal tumour in the adult and renal ectopy is relatively common, the actual incidence among autopsy series is 1 in 900, it has been an uncommon association, with only six cases reported. The surgical approach to ectopic kidneys merits caution because of the uncertain vascular anatomy, and vascular studies may be indicated to avoid complications, the present case is important because it represent the most common urological cancers at our institution with an unusual presentation (AU)