Multilocular cystic nephroma: A clinical case.

OBJECTIVE: To describe the clinical presentation, preoperative diagnostic possibilities, and treatment of cystic nephroma. METHODS: We describe a case of cystic nephroma in an adult male and show that, both in our patient and in the literature, a definitive diagnosis can only be obtained postoperatively, even when there is a reasonable clinical suspicion. CONCLUSIONS: Cystic nephroma is rare, and some authors consider it a questionable entity. However, it should be distinguished from renal cystic neoplasms, which can resemble the condition.

Paraurethral leiomyoma.

OBJECTIVE: To describe a case of para-urethral leiomyoma and to review the literature. METHODS: The usual preoperative diagnostic procedures and clinical manifestations are discussed. RESULTS: The mass was resected and, 6 years later, the patient remains asymptomatic and with no recurrence. CONCLUSIONS: Urethral or paraurethral leiomyomas are benign tumors that arise from the urethral or vaginal smooth muscle. Radiological findings (particularly magnetic resonance imaging) may suggest the origin of the tumor before surgery; however, the final diagnosis is determined by histology.

Neuroendocrine carcinoma of the urinary bladder. 15-year retrospective analysis.

OBJECTIVES: Neuroendocrine tumors (NET) are cancers found in the bronchopulmonary tract, where they were first described in 1926. The tumors are associated with poor prognosis due to their high metastatic potency even after radical treatments associated with other neo- or adjuvant therapies. NET of the urinary bladder is a rare tumor and accounts for 0.5% of bladder tumors. METHODS: The study was designed as an observational, descriptive and retrospective study of 13 patients diagnosed, treated, and followed for NET of the urinary bladder at the Hospital and University Complex of Albacete, Albacete, Spain between 1995 and 2010. RESULTS: The sample was composed of 11 men and 2 women. Mean patient age at the time of diagnosis was 71 (range, 57-88; SD, 6.98) years. T4 (6 patients) was the most common T tumor stage, followed by T2 (5 patients) and T3 (2 patients). In the case of N tumor stage, the most common was N2. In the remaining 3 patients, the degree of lymph node involvement could not be assessed. Six presented distant metastasis at the time of diagnosis. Eleven patients presented small-cell NET on histology. Seven underwent radical surgery (radical cystectomy). All other patients were treated by deep transurethral resection of bladder tumor, except for 1 patient treated by partial cystectomy. Adjuvant chemo-therapy (usually an association of carboplatin/cisplatin and etoposide) was administered to 4 patients. Of these 4 patients, 2 were also treated by pelvic radiotherapy. Two patients survived more than 5 years following diagnosis. In fact, at the time the study data was collected only 4 patients had survived and 2 presented tumor recurrence. Of the 9 deaths, 8 occurred within 6 months of diagnosis and 1 at 24 months. All of them were the result of the disease itself. CONCLUSIONS: Neuroendocrine tumor of the urinary bladder is a rare, aggressive tumor with high metastatic potential that should be considered in the differential diagnosis of urinary bladder neoplasms. Despite various multimodality treatments have been used prognosis is poor.

46,XX T testicular disorder of sex development. Case report.

OBJECTIVE: We present a case of X-Y translocation with male phenotype (46,XX testicular disorder of sex development) and review the literature. METHODS: Disorders of sex development with mismatch of genetic, gonadal and phenotypic sex are quite rare, and some are due to genetic or chromosomal abnormalities. The karyotype was investigated by a cytogenetic study of peripheral blood (phytohemagglutinin-timulated lymphocyte culture over 72 hours). G-banding analysis of 25 metaphases showed a 46,XX chromosome constitution (46 chromosomes with XX sexual composition). Fluorescence in situ hybridization (FISH) analysis with probes for X centromeres and the sex-determining region of the Y chromosome (SRY) (testis-determining factor gene) showed two X chromosomes. The analysis also showed the SRY signal in the telomeric region of the short arm of one of the chromosomes. RESULTS: In recent years, a number of other genes involved in disorders of sex development in animals and humans have also been identified. Genetic defects in the peptide hormone receptors, members of the steroid receptor superfamily, and other transcription factors, as well as any of a series of enzymes and cofactors involved in steroid biosynthesis can cause abnormal determination and differentiation. CONCLUSIONS: Although chromosomal abnormalities are rarely present in patients with apparently normal external genitalia, they should be considered in urology consultations by adolescents and adults, particularly in the investigation of gynecomastia or infertility.

Tumor inside an inguinoscrotal bladder hernia.

OBJECTIVE: To describe two cases of urothelial tumors in inguinoscrotal bladder hernias and comment on the low incidence of this condition. METHODS: Two patients were diagnosed and treated by partial cystectomy and hernia repair. RESULTS: The clinical outcome of both patients was good at two and three years, respectively, and neither patient experienced hernia or tumor recurrence. CONCLUSIONS: Inguinal bladder hernias are relatively common. However, few reports of tumor in the herniated bladder have been published. Treatment consists of tumor removal, hernia repair and treatment of any associated urethroprostatic condition.

[Spermatic cord sarcomas: current status and report of four cases]. / Sarcomas de cordón espermático: estado actual y presentación de cuatro casos clínicos.

OBJECTIVE: To study and review spermatic cord sarcomas, including symptoms, diagnosis, and treatment. METHODS/RESULTS: We review the Spanish and international literature and report 4 new cases: 2 patients with well-differentiated spermatic cord liposarcomas (1 treated by simple tumorectomy), 1 patient with liposarcomatous degeneration of a previously excised atypical lipoma, and 1 patient operated for a malignant retroperitoneal fibrous histiocytoma with subsequent local recurrence in the paratesticular region. CONCLUSIONS: Spermatic cord sarcomas are rare entities that usually appear as painless paratesticular mass. They are diagnosed by imaging studies (ultrasound, computed tomography, magnetic resonance) and confirmed by histological examination. Spermatic cord sarcomas are treated surgically; the efficacy of adjuvant treatments such as chemotherapy or radiation therapy is still under debate.

[Late lymph node metastasis in renal cell carcinoma. Case report]. / Metástasis ganglionar tardía de carcinoma de células renales. Aportación de un caso.

OBJECTIVE: To report one case of late metastasis of a clear cell carcinoma treated by radical surgery. METHODS/RESULTS: Patient with history of radical nephrectomy and lymphadenectomy six years before presenting with regional lymph node metastasis in a followup diagnostic test. After treatment with immunotherapy, stopped because of intolerance, surgery of the metastatic lymph node mass was decided. CONCLUSIONS: Renal cancer is an unpredictable tumor in terms of oncological behaviour, so that it may metastasize any time in its evolution, even after radical surgery and several years free of disease. Surgery for the metastases of renal cancer is a good therapeutic option, with good long-term results, when they are isolated and accessible to surgery.

[Prognostic-factor-related survival in a series of patients with renal cell carcinoma]. / Supervivencia en relación a los factores pronósticos en una serie de pacientes con carcinoma de células renales.

OBJECTIVES: To analyze the survival rate in a series of patients with the diagnosis of renal cell carcinoma over a 19 year period based on prognostic factors usually employed in clinical practice. METHODS: Retrospective study of 259 consecutive patients with the diagnosis of renal cell carcinoma undergoing surgery in our department between 1988 and 2006. From clinical, pathological, and follow-up data we performed a survival study comparing the impact of usual prognostic factors: stage, tumor size, nuclear grade, etc. RESULTS: 264 surgical procedures were performed in 259 patients, with a mean age of 6 1.91 yr. The most frequent way of diagnosis was incidental finding (52.12% of the cases); radical nephrectomy was performed in 72.97% of the cases in comparison with 26.25% partial nephrectomies. Clear cell carcinoma was the most frequent histological diagnosis (69.88%). Patients with clear cell carcinoma, symptomatic tumors, bigger size, and greater Fuhrman nuclear grade presented worse survivals, mainly in tumors with stage >pT3a. The presence of involved lymph nodes or distant metastases is associated with a much lower cancer-specific survival. Global five-year cancer-specific survival was over 80%. CONCLUSIONS: The classical prognostic factors used to predict survival in renal cancer are still useful, mainly pathological stage pT. We observed a better survival in comparison with older series, but this kind of tumors continue generating important morbidity-mortality.

[Bladder endometriosis. Report of two cases and bibliographic review, with special focus on Spanish articles]. / Endometriosis vesical. Revisión de la literatura, con especial referencia a la española y aportacion de dos nuevos casos.

OBJECTIVES: To study and review the etiopathogenic hypothesis for endometriosis and the clinical features, diagnosis and treatment of bladder endometriosis. METHODS/RESULTS: We report two cases and review the international bibliography, collecting the cases published by Spanish authors. CONCLUSIONS: Bladder endometriosis is a rare pathological entity, but its diagnosis should be considered in fertile women with urinary tract symptoms during menstruation. Diagnosis is obtained by various imaging tests (ultrasound, CT scan, MRI), and is confirmed with cystoscopy and biopsy. The treatment may be surgical (TUR, partial cystectomy) and/or medical (hormonal).

Tumor en hernia vesical inguinoescrotal / Tumor inside an inguinoscrotal bladder hernia

OBJETIVO: Mostramos dos casos de neoplasia urotelial en hernias vesicales inguinoescrotales y referimos su escasa incidencia.METODOS: Se describe el diagnóstico y tratamiento efectuado con cistectomía parcial y herniorrafia.RESULTADOS: Ambos pacientes al cabo de dos y tres años respectivamente han tenido buena evolución clínica, sin recidiva herniaria ni del tumor.CONCLUSIONES: Las hernias vesicales inguinales son relativamente frecuentes, pero los casos de tumor en la vejiga herniada son escasos en la literatura. El tratamiento persigue eliminar el tumor, reparar la hernia y tratar si existe la patología uretroprostática (AU)

OBJECTIVE: To describe two cases of urothelial tumors in inguinoscrotal bladder hernias and comment on the low incidence of this condition.METHODS: Two patients were diagnosed and treated by partial cystectomy and hernia repair.RESULTS: The clinical outcome of both patients was good at two and three years, respectively, and neither patient experienced hernia or tumor recurrence.CONCLUSIONS: Inguinal bladder hernias are relatively common. However, few reports of tumor in the herniated bladder have been published. Treatment consists of tumor removal, hernia repair and treatment of any associated urethroprostatic condition (AU)

Nefroma quístico multilocular: a propósito de un caso / Multilocular cystic nephroma: A clinical case

OBJETIVO: Mostrar la presentación clínica, las posibilidades diagnosticas preoperatorias y el tratamiento del nefroma quístico. MÉTODOS: Se presenta un caso de nefroma quístico en un varón adulto, comprobando en nuestro caso y en la revisión de la literatura que aunque exista una razonable sospecha clínica, el diagnóstico cierto solo es posible postcirugía. CONCLUSIONES: El nefroma quístico es de frecuencia escasa y por algunos autores es considerada una entidad dudosa, pero hay que tratar de distinguirla de neoplasias quísticas renales, que pueden simular este proceso

OBJECTIVE: To describe the clinical presentation, preoperative diagnostic possibilities, and treatment of cystic nephroma.METHODS: We describe a case of cystic nephroma in an adult male and show that, both in our patient and in the literature, a definitive diagnosis can only be obtained postoperatively, even when there is a reasonable clinical suspicion.CONCLUSIONS: Cystic nephroma is rare, and some authors consider it a questionable entity. However, it should be distinguished from renal cystic neoplasms, which can resemble the condition

[Large retroperitoneal malignant fibrohistiocytoma: report of one case]. / Fibrohistiocitoma maligno retroperitoneal de gran tamaño: aportación de un caso.

OBJECTIVES: To report one case of a large retroperitoneal malignant fibrohistiocytoma. METHODS/RESULTS: 40-year-old female with the diagnosis of a large right retroperitoneal mass after a study for right flank pain and weight loss over several months. Surgery was performed with excision of a large tumor; the pathologic diagnosis was malignant fibrohistiocytoma. CONCLUSIONS: Primary retroperitoneal tumors are rare neoplasias, usually diagnosed in advanced stages. The malignant fibrohistiocytoma is an infrequent entity with difficult histological diagnosis and poor prognosis. To date, the only valid option is surgery, because adjuvant treatments do not offer clear advantages today.

Paraganglioma of the bladder: controversy regarding treatment.

Paragangliomas or extra-adrenal pheochromocytomas account for approximately 15% of all pheochromocytomas. They are usually found in an intradiaphragmatic location. Paragangliomas of the urinary bladder are infrequent and represent 6% of the paragangliomas and 0.06% of all bladder tumors. We describe 2 cases of urinary bladder paragangliomas attended to our center and review the literature with special attention to treatment, since there is some controversy around the management of these tumors. Surgical options include partial or total cystectomy and transurethral resection, but there is no consensus regarding these treatment modalities. The 2 patients presented underwent transurethral resection with a good outcome and no recurrence or residual disease.

Sarcomas de cordón espermático estado actual y presentación de cuatro casos clínicos / Spermatic cord sarcomas: current status and report of four cases

OBJETIVO: Estudio y revisión de los sarcomas de cordón espermático, de la clínica, diagnóstico y tratamiento de dicha patología.MÉTODOS/ RESULTADOS: Se revisa la literatura nacional e internacional, aportando cuatro nuevos casos: dos liposarcomas de cordón espermático bien diferenciados, uno de ellos tratado mediante tumorectomía simple; un paciente con degeneración liposarcomatoide de un lipoma atípico previo resecado; y otro paciente intervenido de un fibrohistiocitoma maligno retroperitoneal con posterior recidiva local a nivel de la región paratesticular.CONCLUSIONES: Los sarcomas de cordón espermático son una entidad poco frecuente que habitualmente se manifiestan como una masa paratesticular indolente. Su diagnóstico se efectúa mediante métodos de imagen (ecografía, TAC, RNM) y se confirma mediante el estudio histológico. El tratamiento es quirúrgico, existiendo cierta controversia acerca de la eficacia de tratamientos adyuvantes como la quimioterapia o la radioterapia(AU)

OBJECTIVE: To study and review spermatic cord sarcomas, including symptoms, diagnosis, and treat-ment.METHODS/RESULTS: We review the Spanish and international literature and report 4 new cases: 2 patients with well-differentiated spermatic cord liposarcomas (1 treated by simple tumorectomy), 1 patient with liposarcomatous dege-neration of a previously excised atypical lipoma, and 1 pa-tient operated for a malignant retroperitoneal fibrous histio-cytoma with subsequent local recurrence in the paratesticular region.CONCLUSIONS: Spermatic cord sarcomas are rare entities that usually appear as painless paratesticular mass. They are diagnosed by imaging studies (ultrasound, computed tomography, magnetic resonance) and confirmed by histological examination. Spermatic cord sarcomas are treated surgically; the efficacy of adjuvant treatments such as chemotherapy or radiation therapy is still under debate(AU)

Cuerpos extraños en pene / Penile foreign bodies

OBJETIVO: Mostrar 8 casos de cuerpos extraños en pene.MÉTODOS/RESULTADOS: Realizamos una presentación fundamentalmente visual de variados artilugios o cuerpos extraños de ubicación peneana.CONCLUSIONES: Raramente la existencia de cuerpos extraños peneanos se debe a accidentes. Los cuerpos extraños en pene son colocados por muy diversas razones, destacando principalmente dentro de actividades eróticas o autoeróticas, pudiendo tener consecuencias desde leves, a casos en los que puede acabar en amputación peneana(AU)

OBJECTIVE: To describe 8 cases of penile foreign bodies.METHODS/RESULTS: We provide an essentially visual overview of various objects or foreign bodies affecting the penis.CONCLUSIONS: The presence of penile foreign bodies is rarely due to an accident. These objects are placed for a wide variety of reasons, but primarily for erotic or self-arousal purposes. The consequences of penile foreign bodies can be mild or very severe, resulting in penile amputation(AU)

Quistes de rafe medio. Aportacion de dos casos revisión de laliteratura / Median Raphe Cyst. Report of two cases and literature review

OBJETIVOS: Presentar dos casos de quistes de rafe medio, uno de localización peneana y otro perineal.MÉTODO: Se diagnostican y describen dos casos de quiste de rafe medio, a uno se aplicó tratamiento quirúrgico y el segundo no precisó de tratamiento alguno.RESULTADOS: La intervención quirúrgica del paciente operado no tuvo complicaciónes y a los dos años de la misma estaba asintomático y sin recidiva.CONCLUSIÓN: Los quistes de rafe medio son poco frecuentes; es una patología benigna y su etiología no está completamente aclarada. Su tratamiento consiste en la exéresis simple(AU)

OBJECTIVES: To report 2 cases of median raphe cysts, 1 in the penis and the other in the perineum.METHOD: Two cases of median raphe cyst are described; the first was treated by surgery and the second required no treatment.RESULTS: The surgical patient experienced no complications and was asymptomatic with no recurrence at 2 years.CONCLUSIONS: Median raphe cysts are a rare, benign condition of uncertain etiology. Treatment consists on simple excision(AU)

Leiomioma parauretral / Paraurethral Leiomyoma

OBJETIVO: Presentar un caso de leiomioma parauretral y revisar la literatura. MÉTODOS: Se comentan los procedimientos diagnósticos preoperatorios más habituales y las manifestaciones clínicas. RESULTADOS: Tras la exéresis de la tumoración la paciente quedó asintomática, y sin recidiva seis años después. CONCLUSIONES: Los leiomiomas uretrales o parauretrales son tumoraciones benignas derivadas del músculo liso uretral o vaginal, siendo posible intuir preoperatoriamente este origen con pruebas radiológicas especialmente con la RMN, aunque el diagnostico definitivo solo es histológico (AU)

OBJECTIVE: To describe a case of para-urethral leiomyoma and to review the literature. METHODS: The usual preoperative diagnostic procedures and clinical manifestations are discussed. RESULTS: The mass was resected and, 6 years later, the patient remains asymptomatic and with no recurrence. CONCLUSIONS: Urethral or paraurethral leiomyomas are benign tumors that arise from the urethral or vaginal smooth muscle. Radiological findings (particularly magnetic resonance imaging) may suggest the origin of the tumor before surgery; however, the final diagnosis is determined by histology (AU)

Tumor testicular bilateral sincrónico de distancia histología / Bilateral synchronic testicular tumor of different histology

Objetivo: Presentar el caso de un tumor testicular germinal bilateral sincrónico de distinta histología. Método/ Resultado: Se trata de un paciente de 37 años que durante un estudio ecográfico, por sospecha de tumor testicular izquierdo, se apreció una tumoración testicular contralateral sincrónica. Se practicó orquiectomía inguinal bilateral y en el posterior estudio anatomopatológico se confirmó la presencia de la tumoración testicular bilateral de distinto componente histológico. Conclusión: Alrededor del 75% de los casos de tumoración testicular bilateral son metacrónicos, presentándose únicamente el 10% con diferente histología. El tipo histológico suele correlacionarse con el aspecto ecográfico, y el tratamiento de elección de un paciente con patología oncológica de este tipo es la orquiectomía inguinal bilateral (AU)

Objective: To report one case of bilateral synchronic germ cell testicular tumour of different histology. Methods/Results: 37-year-old patient with left testicular tumor under study was found to have a contralateral synchronic testicular tumor on ultrasound. Bilateral inguinal orchiectomy was performed and pathology reported the presence of bilateral testicular tumours of different histological type. Conclusions: Around 75% of the cases of bilateral testicular tumours are metachronic, with only 10% presenting different histology. Histological type often correlates with the ultrasound findings, and the treatment of choice in patients with this type of oncological pathology is bilateral inguinal orchiectomy (AU)

Metástasis ganglionar tardía de carcinoma de células renales. Aportación de un caso / Late lymph node metastasis in renal cell carcinoma. Case report

Objetivo: Presentar un caso de metástasis tardía por carcinoma de células renales tratado con cirugía radical. Método/Resultados: Paciente intervenido de nefrectomía radical y linfadenectomía por tumor renal que 6 años después de la cirugía, en un control rutinario presentó metástasis a nivel ganglionar regional. Tras tratamiento con inmunoterapia, que se suspendió por intolerancia, se decidió cirugía de la masa adenopática metastásica. Conclusión: El cáncer renal constituye un tumor imprevisible en cuanto a su comportamiento, de manera que puede metastatizar en cualquier momento de su evolución, incluso tras cirugía radical y tras varios años libres de enfermedad. La cirugía de las metástasis del cáncer renal constituyen una opción terapéutica con buenos resultados a largo plazo, cuando éstas son únicas y accesibles a la cirugía (AU)

Objective: To report one case of late metastasis of a clear cell carcinoma treated by radical surgery. Methods/Results: Patient with history of radical nephrectomy and lymphadenectomy six years before presenting with regional lymph node metastasis in a follow-up diagnostic test. After treatment with immunotherapy, stopped because of intolerance, surgery of the metastatic lymph node mass was decided. Conclusions: Renal cancer is an unpredictable tumor in terms of oncological behaviour, so that it may metastasize any time in its evolution, even after radical surgery and several years free of disease. Surgery for the metastases of renal cancer is a good therapeutic option, with good long-term results, when they are isolated and accessible to surgery (AU)