Penile metastasis from primary bladder tumour.

OBJECTIVE: We present a case of cutaneous metastasis caused by a bladder tumor. METHODS: 68 year old male, diagnosed with an ISUP high grade urothelial carcinoma, affecting the whole bladder wall, including the perivesicular fat and macroscopic metastasis in the left ilio-obturator chain (T3N2MO), who presents painless induration on the dorsal surface of the glans penis with non-exudative ulcerated areas, evolving over several months. Given the negative serology result, the lesion was biopsied for anatomopathological study. RESULTS: The histopathological study of the lesion corresponded to a cutaneous metastasis from high grade urothelial carcinoma. CONCLUSION: Approximately 370 cases of penile metastasis have been described and the primary tumor is located in the bladder in 30-35% of them. Presentation of these lesions is very heterogeneous and requires anatomopathological study of the lesion for definitive diagnosis.

Fibrous pseudotumor affecting the tunica vaginalis, epididymis and seminal duct.

OBJECTIVE: To report one case of advanced fibrous pseudotumour. METHODS: A 34-year-old patient presented with a painless lump on the right side of the scrotum. Examination revealed a hard tissue thickening attached to the tail and body of the right epididymis. The results of the ultrasound study were not clear and multiple differential diagnosis were considered. The lesion was surgically removed by partial right epididymectomy and resection of the affected tunica vaginalis and ductus deferens for anatomopathological study. RESULTS: The histopathological study revealed an evolved fibrous pseudotumour with bone metaplasia. CONCLUSION: Fibrous pseudotumour is a benign paratesticular lesion that grows slowly and painlessly. It is usually diagnosed by chance or in associated processes such as hydrocele. Differential diagnosis with malignant tumors avoids unnecessary radical treatment.

Testicular cancer: our experience after 10 years.

OBJECTIVES: Testicular cancer represents about 1% of malignant tumors in men. Of these tumors 95% are germ cell tumors (GCTs), which have a maximum incidence between the second and third decades of life. Our objective was to carry out a retrospective analysis of testicular tumor cases that had been diagnosed in our Health Area between the years 2000 and 2010. METHODS: We performed a retrospective descriptive study between the years 2000 and 2010 analyzing 43 patients treated for testicular cancer, including in the analysis tumor incidence, the patient's age, clinic attended, patient's time until appointment, presence of tumor markers, patient's time before treatment, use of testicular prostheses, histological type and their typical characteristics, oncological treatment, tumor progression and mortality rate. RESULTS: We found an incidence of 4-5 cases/100,000 population/year in our Health Area. Two-thirds of the cases were detected in Stage I, and 100% of these cases showed complete remission. Among those with higher stage tumors, two out of three patients were cured after chemotherapy. For the remaining one-third, rescue treatments managed to achieve a remission rate of 66%. Mortality was low and was linked to lymphoma or metastatic dissemination. CONCLUSION: The trend towards early diagnosis with detection during the initial cancer stages, together with current chemotherapy protocols, enables a high cure rate for testicular cancer. Mortality in our series was associated with primary or secondary lymphomas.

[Relevance of clinical and serum parameters on severe urinary sepsis after renal obstruction.] / Importancia de los parámetros clínicos y analíticos de la sepsis grave en la uropatía obstructiva.

INTRODUCTION: Urosepsis is an underdiagnosed entity with high morbidity and mortality and significant associated costs. The delay in diagnosis leads to an increased risk of multiorgan failure and death. Although its prognosis is better than that of other sepsis, the mortality rate is 20 - 40%. OBJECTIVE: Describe the obstructive uropathy cases (OU) that are complicated by severe sepsis (SS) and identify early biomarkers of SS. MATERIAL AND METHODS: Observational and prospective study of 65 patients with urgent high OU. All patients were evaluated at three different times (0, 24 and 48 hours). An SS predictor model has been constructed and a multivariate risk analysis has been carried out. RESULTS: 64.61% (n=42) developed SS (NSS: n=13). The only statistically significant variables in the 3 moments evaluated and that obtained a good area under the curve [AUROC (>0.70)] were the elevation of neutrophils, procalcitonin, and decrease of bicarbonate. At the time of patient admission, the variable that best predicted SS was the elevation of procalcitonin (AUROC:0.919). SS risk factors (p<0.005) were the history of cancer immunosuppression, and/or urinary tract surgeries, complete UO and high blood values of lactate, potassium and decrease of bicarbonate. The potassium-lactate combination on admission predicted SS with a probability function of 0.805. CONCLUSIONS: There is an analytical profile maintained over the time characteristic of SS that allows anearly identification of patients with OU subsidiary of been complicated with SS.

INTRODUCCIÓN: La Sepsis urinaria obstructiva (SUO) es una entidad infradiagnosticada con una elevada morbimortalidad e importantes costes asociados. El retraso en su diagnóstico condiciona un mayor riesgo de fracaso multiorgánico y fallecimiento. Aunque su pronóstico es mejor que el de otros focos de sepsis, su mortalidad es del 20 - 40%. OBJETIVO: Describir los cuadros de uropatía obstructiva (UO) que se complican con sepsis grave (SG) e identificarlos biomarcadores diagnósticos de SG en la UOde forma precoz.MATERIAL Y MÉTODOS: Estudio observacional y prospectivo de 72 pacientes con UO alta ingresados de manera urgente en el Servicio de Urología del Hospital Clínico Universitario de Valladolid. Todos los pacientes del estudio fueron evaluados en tres momentos diferentes (0, 24 y 48 horas). Se ha creado un modelo predictor de SG y se ha realizado un análisis multivariante de riesgo. RESULTADOS: El 64,61% de los pacientes (n=42) desarrolló SG (NSG: n=13). Las únicas variables estadísticamente significativas en los tres momentos evaluados y que obtenían una buena área bajo la curva [AUROC (>0,70)] fueron la elevación de neutrófilos y procalcitonina y la disminución de bicarbonato. En el momento del ingreso la variable que mejor predecía SG fue la elevación de procalcitonina (AUROC: 0,919). Los factores de riesgo de SG (p<0,05) fueron los antecedentes de cáncer, la inmunosupresión y/o cirugías de vías urinarias, la UO completa y los valores elevados en sangre de lactato y potasio y la disminución del bicarbonato en la gasometría venosa. La combinación potasio-lactato al ingreso predecía SG con una función de probabilidad de 0,805. CONCLUSIONES: Existe un perfil analítico, mantenido en el tiempo, característico de SG que permite la identificación precoz de los pacientes con UO subsidiarios de complicarse con SG.

[Cutaneous metastases from transitional cell carcinoma of the bladder producing beta-HCG]. / Metástasis cutáneas de un carcinoma transicional vesical productor de beta-HCG.

In spite of the high incidence of transitional cell carcinoma, cutaneous metastases are infrequent, especially when they are the first sign of metastatic spread, with a low survival rate. Thirty five per cent of transitional cell carcinoma of the bladder have ectopic beta- human chorionic gonadotropin (beta-HCG) production. It has been related with high grade tumors, advanced stage, metastatic disease, radioresistent tumors and low survival rate because of its effect as a growth modulator with a probably antagonist action in the apoptotic cascade. We present a thirty six years old woman affected by a transitional cell carcinoma of the bladder producing beta-HCG that showed two cutaneous metastases as first sign of metastatic disease. The exceptional coincidence of these two circumstances announced a very aggressive tumor behaviour and bad prognostic, with a quickly multiple metastatic dissemination including a pericardic metastases.

[Pelvic recurrence after radical cystectomy for bladder cancer]. / Recidiva pelviana despues de cistectomia radical por cancer vesical.

OBJECTIVES: We report the case of a male patient who had undergone radical cystectomy and orthotopic neobladder for bladder cancer presenting with local recurrence eight months later. METHODS: Diagnostic tests included CT scan and ultrasound guided transrectal biopsy RESULTS: With the diagnosis of local recurrence he underwent chemotherapy and radiotherapy CONCLUSIONS: The pelvic recurrence of transitional cell carcinoma after radical cystectomy is rare and prognosis is poor. It is frequently associated with advanced tumor stage. It should be treated by a multidisciplinary approach.