[Duodenitis Russell bodies. Review of the entity and associations beyond H. pylori]. / Duodenitis con cuerpos de Russell. Revisión de la entidad y posibles asociaciones más allá del H. pylori.

Plasma cells known as "Mott cells" present non-secretable accumulations of immunoglobulins called "Russell bodies". Its presence is related to hematological neoplasms, but it can appear in chronic inflammatory processes. The most common occurrence within the digestive tract is the gastric antrum associated with H. pylori infection. Our patient is added the rare extragastric cases where the association with H. pylori is inconsistent. We have found a frequent appearance of lower digestive and urological neoplasms in relation to these cases, justified by the expression of circulating cytokines in the tumor area that lead to the overactivation of plasma cells. This possible association could lead us to know data about the tumor environment and serve us for early diagnosis or future therapeutic targets.

Cumulative morbidity of ureteroscopy for upper tract urothelial carcinoma.

OBJECTIVE: To assess complications after ureteroscopy (URS) for upper tract urothelial carcinoma (UTUC) management and to assess its postoperative cumulative morbidity burden using the Comprehensive Complication Index (CCI). MATERIALS AND METHODS: Single center retrospective study including patients submitted to URS for UTUC suspicion. URSs were both diagnostic and operative. Postoperative complications were recorded according to the EAU Guidelines and graded according to Clavien-Dindo Classification (CDC). The cumulative postoperative morbidity burden developed by patients experiencing multiple events was assessed using the CCI. Multivariable logistic regression (MLR) analyses identified factors independently associated with the development of any grade and major postoperative complications. RESULTS: Overall, 360 patients with UTUC suspicion were included with a total of 575 URSs performed. The cumulative number of all postoperative complications recorded was 111. In 86 (15%) procedures, patients experienced at least one postoperative complication, while 25 (4.3%) experienced more than one complication. Of these, 16 (14%) were severe (CDC ≥ IIIa). The most frequent type of complications were urinary (34%), bleeding (30%) and infectious (30%). The higher the CDC grade, the higher the median CCI, with a statistically significant increase in median CCI from CDC II to major complications. Patients who experienced intraoperative complications were at higher risk of developing any grade and major postoperative complications at MLR. CONCLUSIONS: Complications after ureteroscopy for UTUC are relatively uncommon events. Patients who experience intraoperative complications are at higher risk of developing postoperative complications. The comprehensive complication index appeared more representative of the cumulative postoperative morbidity rather than the Clavien-Dindo classification.

Prevalence of urinary tract cancer in the Spanish cohort of the IDENTIFY study.

INTRODUCTION: Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. PATIENTS AND METHODS: An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. RESULTS: A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR 1.05 (95% CI 1.03-1.06; P < 0.001)), visible hematuria (VH) OR 2.19 (95% CI 1.13-4.24; P = 0.02)) and smoking (ex-smokers: OR 2.11(95% CI 1.30-3.40; P = 0.002); smokers: OR 2.36 (95% CI 1.40-3.95; P = 0.001)) were associated with higher probability of bladder cancer. CONCLUSION: This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients.

Stromal osseous metaplasia in urothelial carcinoma of the bladder: An unusual and challenging feature. A case report.

A 62-year-old male presented with pain and haematuria starting 3 months before. The computed tomography showed focal and mural bladder thickening with ureteropelvic dilatation. The following transurethral bladder resection revealed a high-grade muscle-invasive urothelial carcinoma. In the subsequent cystoprostatectomy we found the same tumour, but adding focal tumour-associated stromal osseous metaplasia. Ossifying metaplasia is an extremely rare feature in urothelial carcinoma, with a few reported cases and represents a diagnostic challenge, mimicking radiotherapy-induced sarcoma or sarcomatoid carcinoma.

Osteoclast-rich undifferentiated carcinoma of the bladder and the diagnostic usefulness of immunohistochemistry. A case report.

Osteoclast-rich undifferentiated carcinoma (ORUC) of the urinary tract is a rare variant of urothelial carcinoma, first described in 1985 by Kitazawa et al. It has a worse prognosis compared to other histological variants of invasive urothelial carcinoma and its diagnosis may prove challenging due to the variability in its immunohistochemical profile. We present a case of ORUC in which GATA3 immunostaining was a useful diagnostic tool.

[Practical aspects of PD-L1 assessment in the treatment of urothelial carcinoma: Consensus of the uropathology group of the SEAP]. / Aspectos prácticos sobre la determinación de PD-L1 en el tratamiento de carcinoma urotelial. Consenso del grupo de uropatología de la SEAP.

The recent addition of novel immunotherapy drugs for the treatment of urothelial carcinoma makes it necessary the establishment of criteria to harmonize the immunohistochemical assessment of PD-L1, both as a prognostic factor and for the selection of patients to be treated. In this scenario, a group of uropathologists from the Spanish Society of Pathological Anatomy, together with a medical oncologist as an external collaborator subspecialized in uro-oncology, have prepared this document of recommendations based on the available evidence. During PD-L1 assessment it is especially relevant the selection of the sample, its processing, the immunohistochemical platform and antibody used, and the algorithm applied in the interpretation of results. All these aspects must be indicated in the results report, which should be easily interpretable in a context of rapid evolution of immunological therapies.

PD-L1 immunoexpression and molecular characterization of histological subtypes in urothelial carcinoma.

INTRODUCTION: Urothelial carcinoma (UC) has histological subtypes whose phenotype reflects their molecular diversity, behavior and response to conventional therapy. Immune checkpoint inhibitors (ICIs) have improved the management of UC by evaluation of PD-L1. In the case of PD-L1 22C3, the initiation of ICI is considered from a combined positive score (CPS) greater than 10. However, UC subtypes with absent PD-L1 22C3 expression in cases with CPS>10 may not respond to these treatments. This study aims to establish a correlation between the PD-L1 immunoexpression and molecular alterations in divergent differentiation and histological subtypes of UC (UC-s). MATERIAL AND METHODS: Twenty-six samples of UC were detected from a total of 24 patients. Two pathologists performed separately an assessment of UC-s on hematoxylin-eosin as well as PD-L1 expression. Molecular study of each case was performed by next generation sequencing (NGS). A descriptive analysis of the variables included was conducted. RESULTS: Nine cases (34.61%) showed a CPS>10, some with negative PD-L1 immunoexpression in aggressive UC-s. The molecular study revealed alterations in genes belonging to the p53/cell cycle control, RAS, and DNA repair pathways, among others. None of the alterations were exclusive to any histological subtype. DISCUSSION: Special attention should be paid to CPS>10 cases that include histological subtypes of UC with divergent expression for PD-L1 as they may not respond to treatment with ICI. We recommend examining the proportion and PD-L1 status of each subtype, especially if it has aggressive behavior.

[How has the Paris System contributed to urine cytology? Evaluating the contribution of the Paris System to urine cytology. A comparative study of the Paris System and the Papanicolaou method in a tertiary centre]. / ¿Qué ha aportado el sistema de París al diagnóstico en citología de orina? Estudio comparativo del sistema de París con el sistema clásico en un centro terciario.

INTRODUCTION AND OBJECTIVES: The Paris System (PS) has replaced the classical Papanicolaou System (PapS) in reporting urine cytology, due to its improved sensitivity and negative predictive value (NPV) without loss of specificity. Furthermore, it has enabled the risk of malignancy to be established in each cytological category. The aim of this study is to compare the Paris System with previous results and determine the changes in sensitivity, specificity, positive predictive value, NPV and risk of malignancy in our centre, MATERIALS AND METHODS: Evaluation of the diagnostic power of urine cytology by means of a retrospective cohort study, comparing two series of 400 cytological studies, one using the Papanicolaou System and the other the Paris System. RESULTS: In the detection of high-grade urothelial carcinoma, Paris System has better specificity (93.82% PapS vs 98.64% PS; P=.001) and PPV (39.5% PapS vs 70.6% PS; P=.044) than Papanicolaou System, without changes in sensitivity (53.5% PapS vs 37.5% PS; P=.299) or NPV (96.4% PapS vs 94.8% PS; P=.183). The risk of malignancy for the atypical category increases from low to high levels (1.6% PapS vs 40.0% PS; P=.001); the other categories showed no significant statistical changes. CONCLUSION: The Paris System improves specificity and positive predictive value and establishes a better indication of risk of malignancy for each category, enabling specific clinical management in each case.

Prognostic significance of age, sex, race, and socioeconomic status in patients with stage III-IV upper tract urothelial carcinoma.

OBJECTIVE: To assess the trend of incidence and survival stratified by age, race, gender and SES and the differences in time between groups in stage III-IV upper tract urothelial carcinoma (UTUC) patients. METHODS: 7,505 stage III-IV UTUC patients between 2004 and 2015 were extracted from the Surveillance, Epidemiology and End Results (SEER) database. The overall survival (OS) and the cancer-specific survival (CSS) rates were assessed using the Kaplan-Meier curve and log-rank test as well as multivariate Cox regression analysis. RESULTS: Among the 7,505 patients, 3,584 were classified as young, 2,464 were classified as middle-aged, and 1,461 were classified as elderly. The years of diagnosis were divided into three periods including 2004-2007, 2008-2011 and 2012-2015. The incidence rates for UTUC were 0.69, 0.74, and 0.77 per 100,000 in the first, second, and third period, respectively. Disparities in the long-term survival rate between male and female patients and among patients of different races narrowed over time. There was no difference in prognosis between races (p = 0.078 for OS and p = 0.167 for CSS). The difference in survival rate between the poor and rich groups narrowed along with the three time periods. CONCLUSIONS: Survival rate disparities according to sex, race, and socioeconomic status narrowed in time, except in patients aged 74-82 years. Increased age, black race, and poverty are associated with worse survival outcomes. In general, the long-term survival rate improved continuously across the three periods.

[Lymphoepithelioma-like bladder tumor. A rare variant.] / Tumor vesical linfoepitelioma-like. Una variante infrecuente.

INTRODUCTION: Lymphoepitheliomalikedifferentiation is a rare histological variant of urothelialbladder carcinoma, therefore its prognosis and treatmentare not clearly defined. A retrospective study of 5cases in the last 10 years in our center was performed. CASE REPORT: cystectomy was performed in 4 of5 because they were non-metastatic muscle-invasivetumors at diagnosis, in the 5th TURB + BCG because itwas non-muscle-invasive. 2 patients received chemotherapyand 1 adjuvant radiotherapy, and 1 immunotherapyafter relapse. 2 had a pure lymphoepithelioma-like pattern, 2 predominant and 1 focal. DISCUSSION: In predominant or pure forms, agood response to treatment with TURB and adjuvantchemotherapy has been described, even superior tocystectomy, as it is a variant with a very favorable responseto platinum. Immunotherapy is currently onlyindicated as second-line treatment. CONCLUSIONS: adjuvant treatment plays an importantrole as it is a highly chemosensitive variant, but more studies are needed to define the best therapeuticstrategy.

INTRODUCCIÓN: La diferenciaciónlinfoepitelioma-like es una variante histológica pocofrecuente del carcinoma urotelial vesical, por lo que supronóstico y tratamiento no está claramente definido.Se presenta un estudio retrospectivo de 5 casos en losúltimos 10 años en nuestro centro.DESCRIPCIÓN DE CASOS: en 4 de los casos se realizócistectomía por ser tumores músculo-invasivosno metastásicos al diagnóstico, en el 5º RTU + BCGpor ser no músculo-invasivo. 2 pacientes recibieronquimioterapia y 1 radioterapia en adyuvancia, y 1 inmunoterapiatras recidiva. 2 presentaban un patrónlinfoepitelioma-like puro, 2 predominante y 1 focal.DISCUSIÓN: en formas predominantes o puras seha descrito buena respuesta al tratamiento con RTU yquimioterapia adyuvante, incluso superiores a cistectomía,por ser una variante con respuesta muy favorableal platino. La inmunoterapia actualmente solo estáindicada como tratamiento en segunda línea. CONCLUSIONES: el tratamiento adyuvante tiene unpapel importante por ser una variante muy quimiosensible,pero son necesarios más estudios para definirla mejor estrategia terapéutica.

Prognostic value of urinary cytology for detecting urothelial carcinoma recurrence after radical cystectomy.

INTRODUCTION: Urethral or upper urinary tract (UUT) recurrence of urothelial carcinoma (UC) after radical cystectomy (RC) are rare (4-6%), and their diagnosis usually occurs within the first two years. Although it is known that its early detection offers benefit in terms of survival, currently there are no clear recommendations for the detection of recurrence in the remnant urothelium (RU). Our aim is to determine the diagnostic value of urinary cytology for the detection of recurrences in the RU and to estimate its impact as an early diagnostic method on survival. MATERIAL AND METHODS: Retrospective review of patients who underwent RC for urothelial carcinoma between 2008-2016, with a follow-up of at least 24 months. RESULTS: The study included 142 patients. In a median follow-up of 68.5 months, nine patients (6.3%) presented recurrences in the RU (urethra: four, UUT: four, synchronous: one). The sensitivity and specificity of urinary cytology for the diagnosis of UUT recurrences were 20% and 96%, respectively. No significant differences were found between overall survival and cancer-specific survival among patients according to the urinary cytology results. CONCLUSION: Recurrences in the RU after RC are infrequent; our study has shown that urinary cytology offers a low sensitivity for their diagnoses. For these reasons, we do not consider that urinary cytology provides useful information for surveillance of these patients.

The benefit of a neoadjuvant instillation of chemotherapy in non-muscle invasive bladder cancer: Interim analysis of the PRECAVE randomized clinical trial. / El beneficio de una instilación neoadyuvante de quimioterapia en el carcinoma vesical no músculo invasivo: análisis intermedio del ensayo clínico aleatorizado PRECAVE.

OBJECTIVE: Although an immediate postoperative instillation of chemotherapy (IPOIC) after transurethral resection of bladder tumors (TURBT) is recommended for the prevention of recurrences of non-muscleinvasive bladder cancer (NMIBC), evidence shows there is an important compliance failure worldwide. We believe that an immediate neoadjuvant instillation of chemotherapy (INAIC) can act similarly, reducing the recurrence risk of NMIBC. Here we present the interim analysis of the PRECAVE clinical trial. MATERIAL AND METHODS: Patients with clinically diagnosed NMIBC were randomized to receive an INAIC with mitomycin C before TURBT (Group A) or to a control group with TURBT only (Group B). Primary end point was to compare the efficacy of an INAIC in the early recurrence-free survival (RFS). Secondary end points were: RFS in patients who did not receive adjuvant treatments, toxicity, and feasibility. RESULTS: A total of 124 patients with Ta/T1 G1-G3NMIBC were included in the initial analysis (Group A:64, Group B: 60). Demographics, risk classification, complications, and adjuvant treatments were balanced between groups. Eighty-four patients (Group A: 45, Group B: 39) who completed a one-year follow-up were included in the efficacy analysis and no difference was observed in the RFS between groups (p=0.3). In the subgroup of patients who did not receive adjuvant treatments, we found a significant difference in favor of an INAIC (p=0.009) and an 80% reduction in the risk of early recurrences (Hazard Ratio: 0.20; 95% confidence interval: 0.05-0.81; p=0.0024). No differences were observed in adverse events. Only 4 patients did not receive an INAIC despite being planned. CONCLUSIONS: In this interim analysis, although we could not demonstrate a reduction in the RFS of all patients, we did find a significant decrease of recurrences in patients who did not receive adjuvant treatments. The administration of an INAIC seems to be safe and our protocol appears feasible and reproductive.

OBJETIVO: Aunque el uso de una instilación postoperatoria inmediata de quimioterapia (IPOIQ) tras una resección transuretral vesical (RTUV) esta recomendada para prevenir recurrencias de carcinoma vesical no músculo invasivo (CVNMI), no se llega a realizar en muchos casos debido a fallos en su cumplimiento. Nosotros creemos que una instilación neoadyuvante inmediata de quimioterapia (INAIQ) puede actuar de manera similar reduciendo el riesgo de recurrencias. Presentamos el análisis intermedio del ensayo clínico PRECAVE.MATERIAL Y MÉTODOS: Se aleatorizó a pacientes diagnosticados de CVNMI a recibir una INAIQ con mitomicina C antes de la RTUV (Grupo A) o a un grupo control con RTUV solamente (Grupo B). El objetivo primario fue comparar la eficacia de una INAIQ en la supervivencia libre de recurrencia (SLR) temprana. Los objetivos secundarios fueron la SLR en pacientes que no recibieron tratamientos adyuvantes, toxicidad y viabilidad. RESULTADOS: Analizamos un total de 124 pacientes con CVNMI Ta/T1G1-G3 fueron analizados (Grupo A:64, Grupo B: 60). No se encontraron diferencias entre datos demográficos, grupos de riesgo, complicaciones o tratamientos adyuvantes. Para el análisis de eficacias e incluyeron 84 pacientes (Grupo A: 45, Grupo B:39) con al menos un año de seguimiento, sin observar diferencias en la SLR (p=0,3). Sin embargo, en el subgrupo que no recibió tratamientos adyuvantes, sí encontramos una diferencia significativa a favor de la INAIQ (p=0,009), y una reducción del riesgo de recurrencias tempranas del 80% (Hazard Ratio: 0,20; intervalo de confianza 95%: 0,05-0,81; p=0,0024). No se observaron diferencias en la aparición de eventos adversos. Solo 4 pacientes no recibieron un INAIC a pesar de estar planificado. CONCLUSIONES: En este análisis intermedio, aunque no pudimos demostrar una reducción en la SLR de todos los pacientes, sí encontramos una diferencia en el subgrupo que no recibió tratamientos adyuvantes. La administración de una INAIC parece ser segura, y nuestro protocolo parece factible y reproducible.

History of urological malignancies before kidney transplantation, oncological outcome on the long term. / Antecedentes de neoplasias urológicas previos al trasplante renal. Resultados oncológicos a largo plazo.

INTRODUCTION: We aimed to report the oncological outcomes of ESRD patients with histories of urological malignancies who were subsequently submitted to kidney transplantation (KT). MATERIAL AND METHOD: Retrospective study lead in the Puigvert Foundation (Barcelona) registry of 1,200 KT performed from 1988 to 2018. Eighty-five urological malignancies that were treated before KT in 81 patients were identified: 15 (18%) prostate cancers, 49 (58%) RCC, 19 (22%) urothelial carcinomas and 2 (2%) testicular cancers. Baseline characteristics, cancer staging, treatment and follow-up were registered as well as the chronology of the start of dialysis, inscription on the waiting list and kidney transplantation. Endpoints included were cancer recurrence, metastatic progression, cancer-specific death and overall survival. RESULTS: In a median follow-up of 13.1 years (2.2-32), 16/85 (19%) cancer recurrences were reported, with 3 (4%) who progressed to metastasis and died of cancer. Median overall survival after cancer treatment was 25.3 years and cancer-specific survival was 95% at 25 years. Median time from cancer treatment to kidney transplantation was 4.8 years: 3.7 years in prostate cancer, 3.9 years in RCC and 8.8 years in bladder cancer. The median time from start of dialysis to kidney transplantation was 1.8 years in patients with histories of urological malignancy versus 0.5 year in the total cohort of 1,200 renal transplanted over the same period. CONCLUSIONS: Well-selected patients with histories of urological malignancies greatly benefit from kidney transplantation with infrequent and late cancer recurrence. Waiting time could be optimized in low-risk prostate cancer and RCC, but more robust data are needed.

History of urological malignancies before kidney transplantation, oncological outcome on the long term.

INTRODUCTION: We aimed to report the oncological outcomes of ESRD patients with histories of urological malignancies who were subsequently submitted to kidney transplantation (KT). MATERIAL AND METHOD: Retrospective study lead in the Puigvert Foundation (Barcelona) registry of 1,200 KT performed from 1988 to 2018. Eighty-five urological malignancies that were treated before KT in 81 patients were identified: 15 (18%) prostate cancers, 49 (58%) RCC, 19 (22%) urothelial carcinomas and 2 (2%) testicular cancers. Baseline characteristics, cancer staging, treatment and follow-up were registered as well as the chronology of the start of dialysis, inscription on the waiting list and kidney transplantation. Endpoints included were cancer recurrence, metastatic progression, cancer-specific death and overall survival. RESULTS: In a median follow-up of 13.1 years (2.2-32), 16/85 (19%) cancer recurrences were reported, with 3 (4%) who progressed to metastasis and died of cancer. Median overall survival after cancer treatment was 25.3 years and cancer-specific survival was 95% at 25 years. Median time from cancer treatment to kidney transplantation was 4.8 years: 3.7 years in prostate cancer, 3.9 years in RCC and 8.8 years in bladder cancer. The median time from start of dialysis to kidney transplantation was 1.8 years in patients with histories of urological malignancy versus 0.5 year in the total cohort of 1,200 renal transplanted over the same period. CONCLUSIONS: Well-selected patients with histories of urological malignancies greatly benefit from kidney transplantation with infrequent and late cancer recurrence. Waiting time could be optimized in low-risk prostate cancer and RCC, but more robust data are needed.

[Current status for urpper tract transitional cell carcinoma during COVID-19 pandemia.] / Situación actual de los tumores del tracto urinario superior en el contexto de la pandemia por Covid-19.

INTRODUCTION: First cases of COVID-19 were reported in China on December 2019 and rapidly spread globally. The explosive increase in number of cases requiring hospitalization has led to a delay in a big number of surgical interventions, including oncologic surgeries. Collateral effects of this increase means a challenge for urologists, who have been forced to redistribute their resources. Due to its poor pronostic, patients suffering from by upper tract urinary tumours will be negatively affected by this pandemic. METHODS: A non sistematic review was performed using literature published until May 23, 2020, using "Uppertract urothelial tumours", "COVID-19" and "nephroureterectomy".as keywords. The resulting manuscript was critically revised by national authors in order to establish common criteria about treatment and follow up. EVIDENCE SYNTHESIS: Four studies were identified that assessed the impact of delaying radical nephrouretrectomy as curative treatment. These studies showed that surgery delays decrease overall survival and cancer specific survival rates in high-risk groups. On the other hand, delaying radical nephrouretrectomy due to ureteroscopy did not affect survival in cohorts of patients with predominately low-grade disease. CONCLUSIONS: A delay in curative treatment of upper tract urothelial tumours for more than three months results in adverse outcomes as overal survival and cancer specific survival. Hence, it is important to prioritize the timely care of this group of patients as far as COVID-19 pandemic allows it.

INTRODUCCIÓN: Los primeros casos de la enfermedad por coronavirus (Coronavirus Disease 19, también denominada COVID-19) aparecieron en China en diciembre de 2019, desde donde se extendieron al resto del mundo. La rápida aparición de casos y el alto volumen de pacientes que han requerido hospitalización han provocado la demora de un gran número de intervenciones quirúrgicas, incluidas las cirugías oncológicas. Todo ello está suponiendo un reto para los servicios de urología de todo el mundo, y obliga a una redistribución de sus recursos. Los pacientes con tumores del tracto urotelial superior (TUS), en muchos casos de mal pronóstico, se pueden ver potencialmente afectadospor esta situación.MATERIAL Y MÉTODOS: Se realizó una búsqueda no sistemática en web y en PubMed utilizando las palabras clave "Upper tract urothelial tumours", "COVID-19" , "nephroureterectomy". Se realizó una revisión narrativa de la literatura incluyendo solo artículos y documentos escritos en lengua española e inglesa. Se remitió el documento a varios autores nacionales expertos en patología del urotelio superior, con el fin de unificar criterios y experiencias para llegar a un rápido consenso sobre la importancia relativa de las distintas actividades, problemas y soluciones. EVIDENCIA CIENTÍFICA: Diversos estudios tratan de determinar el impacto que presenta el retraso en la realización de la nefroureterectomía como tratamiento curativo, siendo el punto de corte de 3 meses en la mayoría de ellos. Tres de ellos concluyen que dicha demora implica una disminución de la supervivencia global y cáncer específica, mientras que el retraso de la nefroureterectomía radical debido a la realización de ureterorrenoscopia (URS) como tratamiento conservador en tumores de bajo grado no parece tener impacto en la supervivencia. CONCLUSIONES: El retraso en el tratamiento de los tumores del TUS a 3 meses supone una disminución de la supervivencia global y cáncer específica. Por ello, el tratamiento de esta patología no debería demorarse, en la medida en que los recursos hospitalarios y la alerta sanitaria por COVID-19 lo permita.

[Plasmacytoid variant of urothelial bladder cancer. A single center experience.] / Cáncer de vejiga variante plasmocitoide. Experiencia de un único centro.

INTRODUCTION: Bladder Cancer (BC) is11th most common malignancy. In terms of pathology, the vast majority of patients suffer from transitional cell carcinoma. Apart from this common type of BC, there are many morphological subtypes with different oncological characteristics. Plasmacytoid BC is a well-recognized subtype of BC with great diagnostic importance as it usually presents in locally advanced or even metastatic stage. OBJECTIVE: The objective of this study was to evaluate our experience in diagnosing and treating patients with this rare BC subtype. METHODS: A retrospective analysis of 5 patients diagnosed with plasmacytoid BC in our department during they ears 2014-2016 was performed. Transurethral resection of the tumors was performed in all patients and pathology diagnosis of plasmacytoid variant was based on several morphologic and immunohistochemical parameters. Staging included abdominal and thoracic CT. RESULTS: 3 of 5 patients were diagnosed with metastatic disease. These patients were referred to the oncology department. 2 patients presented with non-metastatic BC after initial staging and thus a radical cystectomy was performed. Follow up of all patients was carried out and their survival was recorded. CONCLUSIONS: We concluded that despite the fact that the plasmacytoid variant of BC is rare, it is important to take into account the pathologic and clinical features of this tumor in order to manage the optimal treatment of this poor prognosis cancer.

INTRODUCCIÓN: El cáncer de vejiga es el 11o cáncer mas común. Del punto de vista de la patología, la mayoría de pacientes tienen carcinoma urotelial de vejiga.A parte de la forma mas común, el cáncer de vejiga plasmocitoide es un subtipo ampliamente reconocido de cáncer de vejiga con una gran importancia diagnóstica  ya que habitualmente se presenta como localmente avanzadoo en estadio metastático.OBJETIVO: El objetivo de este estudio fue evaluar nuestra experiencia en el diagnóstico y tratamiento en pacientes con esta entidad.MÉTODOS: Análisis retrospectivo de 5 pacientes diagnosticados con cáncer de vejiga plasmocitoide en nuestro departamento entre 2014 y 2016. Se realizó una resección transuretral de vejiga en todos los pacientes y un análisis histopatológico que demostró la variante plasmocitoide del punto de vista morfológico e immunohistoquímico. El estadiaje incluyó TAC toracoabdominopélvico.RESULTADOS: 3 de los 5 pacientes fueron diagnosticado sen estadio metastático. Estos pacientes pasaron a cargo del departamento de oncología medica. 2 pacientes se diagnosticaron en estadio localizado por lo que se realizó una cistectomía radical.  Se realizó el seguimiento y se determinó la supervivencia de estos pacientes. CONCLUSIONES: Se concluye que todo y que el diagnóstico de cáncer de vejiga plasmocitoide es raro; es importante reconocer esta variedad histológica para poderdar un manejo optimo a esta variedad con muy mal pronostico.

[Analysis of the impact on the overall survival of laparoscopic Vs open nephroureterectomy in locally advanced upper tract urinary tumors (pT3-pT4).] / Análisis del impacto en la supervivencia global de la nefroureterectomía laparoscópica vs abierta en los tumores del tracto urinario superior localmente avanzados (pT3-pT4).

OBJECTIVE: To compare the impact onoverall survival (OS) of laparoscopic nephroureterectomy (LNU) vs open nephroureterectomy (ONU) in patients with locally advanced upper tract transitional cell carcinoma (UTTCC) (pT3-pT4). MATERIAL AND METHODS: Sixty-six patients underwent LNU/ONU at our institution between March 2001 and August 2016 (36 ONU and 30 LNU) with confirmed UTTCC diagnosis. Demographic, histological and survival variables were extracted. The statistical analysis was performed using Chi-square test, Exact Ficher test,log-rank test and Cox regression analysis. RESULTS: The median time of follow-up was 14.3 months (Q1-Q3 6.6, 38.8). No differences were found between both groups in terms of demographic or pathology variables. The median survival time was 11.6 months (IQR 5.0- 18.2) in the ONU group and 33.8 months (IQR 2.5-65.2) in the LNU group. The 5y OS rate was 14% in the ONU group and 37% in the LNUgroup. Surgical approach, ASA or pT and the multifocality showed a statistically significant association with OS. CONCLUSION: Our study shows an association between the surgical approach and OS, with increased mortality associated to the ONU.

OBJETIVO: Comparar el impacto en la supervivencia global (SG) de la nefroureterectomía laparoscópica (NUL) Vs Nefroureterectomía abierta (NUA) en pacientes afectados de carcinoma urotelial del tracto urinario superior (CUTUS) localmente avanzado (pT3-pT4).MATERIAL Y MÉTODOS: Se estudiaron 66 pacientes intervenidos en nuestro centro entre marzo de 2001 y agosto de 2016 (36 NUA y 30 NUL) y con diagnóstico anatomopatológico de CUTUS. Se recogieron variables demográficas, histológicas y de supervivencia. El análisis estadístico se realizó empleando los test chi-cuadrado, test exacto de Ficher, log-rank test y análisis de regresión de Cox. RESULTADOS: El tiempo mediano de seguimiento fuede 14,3 meses (Q1-Q3: 6,6-38,8). No se encontraron diferencias entre ambos grupos en cuanto a las variables demográficas ni anatomopatológicas. El tiempo mediano de supervivencia fue de 11,6 meses (Q1-Q3:5,0-18,2) en el grupo NUA y de 33,8 meses (Q1-Q3:2,5-65,2) en el grupo NUL. La tasa de supervivencia global estimada a 5 años fue de 14% en el grupo NUA y de 37% en el grupo NUL. El tipo de abordaje quirúrgico,la clasificación de riesgo anestésico de la American Society of Anesthesiologists (ASA), el estadío local (pT) y la multifocalidad mostraron una asociación estadísticamente significativa con la SG.CONCLUSIÓN: Nuestro estudio muestra una asociación entre el abordaje quirúrgico y la SG, con una mayor mortalidad asociada al abordaje convencional.

[Lipid cell variant urothelial carcinoma of the renal pelvis. A case report and literature review]. / Carcinoma urotelial lipoideo de pelvis renal. Aportación de un nuevo caso y revisión de la literatura de esta variante de carcinoma urotelial.

There are many variants of urothelial carcinoma. One of the most infrequent is formed by cells with a lipid content and an adipose tissue appearance. Only 43 cases have been reported in the bladder, 2 in the renal pelvis and 1 case in the ureter. We present a third case in the renal pelvis; the patient is alive and free of disease 103 months post diagnosis.

[Local and systhemic immunotherapy for bladder cáncer: from bench to bedside.] / Inmunoterapia local y sistémica en cáncer de vejiga: bases moleculares y traslación clínica.

Therapeutic approaches for treatment of urothelial transitional cell carcinoma based on immune system modulation, as well as the contribution of intravesica Bacillus de Calmette-Guérin (BCG) and the recentin corporation of checkpoint inhibitors had found irrefutable proofs of concept for the indication of antitumoral immunontherapy in such tumors. Its extension and development at the present time covers all the locations of the wide spectrum of presentation and evolution of these tumors. Nowadays, apart for the low grade non muscle-invasive tumors, we are facingan unpredictable development of antitumoral immunotherapy in bladder cancer not only as an option in the primary treatment, but also in other scenarios such asnon-responders when it comes to BCG, or the situation of ineligibility for systemic chemotherapy indication. The main objective of this review article is trying to translate the current basic mechanisms involved in different phases of transitional cell carcinomas antitumoral response, regardless of whether they are muscle-invasive or not, and to establish the rationale for their therapeutic intravesical or systemic administration. The role of the interactions established between urothelial tumor cells and the cellular and molecular elements of the immune system of patients is described, incorporating the relevant and recent advances in immunobiology and the molecular characterization of these tumors thatwill undoubtedly introduce far-reaching modifications intherapeutic regimes that will contrast with the traditional options available. Investigational lines that are already active in the clinical research phase with BCG and, checkpoints inhibitors ofthe immune response are also analyzed, high lighting theneed to find predictive response markers as a real option for treatments personalization. The approach to the knowledge of the individual reactivity of the immune system of each patient as a determining factor to achieve it is proposed.

Los abordajes terapéuticos para los carcinomas de células transicionales del urotelio desarrollados en torno a la modulación del sistema inmune encuentran, en la contribución del Bacillus de Calmettey Guérin (BCG) intravesical y más reciente la de los fármacos inhibidores de los puntos de control de la respuesta inmunitaria, indiscutibles pruebas de concepto de la indicación inmunoterapia antitumoral. Su extensión y desarrollo en el momento actual abarca todas las localizaciones del amplio espectro de presentación y evolución de estos tumores. A excepción, por el momento, de los tumores no-músculo infiltrantes debajo grado, acudimos a un desarrollo impredecible de la inmunoterapia antitumoral en el cáncer de vejiga no solo como opción en el tratamiento primario de alguno de ellos sino también en pacientes no-respondedores cuando se trata del BCG, de la quimioterapia sistémicao la situación de no-elegibilidad para su indicación. El objetivo de este artículo de revisión es intentar trasladar los mecanismos básicos actuales implicados en las distintas fases de la respuesta antitumoral de los carcinomas de células transicionales con independencia de que sean o no músculo infiltrantes y establecer los fundamentos para su traslación terapéutica por vía intravesical o sistémica. Se describe el papel de las interacciones que se establecen entre las células tumorales uroteliales y los elementos celulares y moleculares del sistema inmune de los pacientes incorporando los relevantes y recientes avances de la inmunobiológica y la caracterización molecular de estos tumores que sin duda introducirán modificaciones de alcance en su evolución y tratamiento que contrastaran con las opciones hasta hace poco tiempo disponibles. También se analizan las líneas de futuro ya activas en fase de investigación clínica con BCG y con inhibidores de los puntos de control de la respuesta inmunitaria destacando la necesidad de avanzar en la búsqueda de marcadores predictivos de respuesta como opción real para la personalización de los tratamientos planteando la aproximación al conocimiento de la reactividad individual del sistema inmune de cada paciente como factor determinante para poder alcanzarla.

[Muscle invasive bladder cancer and bladder preservation protocols. Where are we?] / Cáncer vesical músculo invasivo y preservación vesical ¿dónde estamos?

Radical cystectomy remains as gold standard for treatment of muscle-invasive bladder cancer. Radical cystectomy has a high morbidity and mortalityas sociated even with the new anesthetic and surgical techniques. Some patients are still not candidates for this major surgery. Besides, some patients reject radical cystectomy. Bladder preservation strategies were develop aiming to decrease morbidity and mortality related to major surgery. Bladder preservation allow for improved quality of life and similar oncologic control rates. Radical cystectomy remains as gold standard for treatment of muscle-invasive bladder cancer. Radical cystectomy has a high morbidity and mortality associated even with the new anesthetic and surgical techniques. Some patients are still not candidates for this major surgery. Besides, some patients reject radical cystectomy. Bladder preservation strategies were develop aiming to decrease morbidity and mortality related to major surgery. Bladder preservation allow for improved quality of life and similar oncologic control rates.Bladder preservation has historically been used in 2clinical scenarios: 1) Patients unable to under go a radicalcystectomy due to comorbidities o patients that rejectradical cystectomy, and 2) patients that are offeredbladder preservation strategies with and oncologicalsafety and curative intent.This is the real scenario for bladder preservation, thefirst scenario belongs to palliation, not cure.In the current manuscript, we will review the bladderpreservation strategies for muscle invasive bladdercancer, specially focusing on trimodal therapy (recommendedby international guidelines) and tetramodaltherapy.

Mientras que la cistectomía radical continúa siendo el tratamiento estándar en el carcinoma urotelial músculo infiltrante (CVMI) y así está refrendada por todas las guías clínicas internacionales, esta cirugía conlleva una importante morbilidad y mortalidad, así pues, y pese a las mejoras en la técnica quirúrgica, anestésica y la optimización perioperatoria, esta cirugía aún no es posible en todos los pacientes. A esta limitación obvia, hay que añadir pacientes que, por cualquier motivo, rechazan la cistectomía. Por todo ello, y como ocurre en otros cánceres, debemos desarrollar estrategias de preservación vesical, encaminadas a disminuir la morbi-mortalidad de la cirugía radical. Estrategias que permitan una mejor calidad de vida, con un menor impacto en la esfera funcional, al tiempo que permiten un control oncológico seguro para el paciente. Tradicionalmente, la preservación vesical se ha aplicado en dos contextos clínicos bien distintos: 1) Pacientes no candidatos a CR por su comorbilidad o porque rechazaran la cirugía y 2) Pacientes a los que, siendo subsidiarios de cirugía radical, se les ofrece una estrategia de preservación vesical, como una alternativa oncológicamente segura y con intención curativa. Es este último, el contexto en el que debemos entender la preservación vesical, lo contrario es un mero ejercicio de paliación. En este artículo, revisaremos las distintas estrategias de preservación en el CVMI, centrándonos en las series más actuales, en particular, la terapia trimodal (TMT), recomendada por las guías internacionales y, la prometedora terapia tetramodal.