HPV-negative Penile Intraepithelial Neoplasia (PeIN) With Basaloid Features.

Most human papillomavirus (HPV)-independent penile squamous cell carcinomas (PSCCs) originate from an intraepithelial precursor called differentiated penile intraepithelial neoplasia, characterized by atypia limited to the basal layer with marked superficial maturation. Previous studies in vulvar cancer, which has a similar dual etiopathogenesis, have shown that about one fifth of HPV-independent precursors are morphologically indistinguishable from high-grade squamous intraepithelial lesions (HSILs), the precursor of HPV-asssociated carcinomas. However, such lesions have not been described in PSCC. From 2000 to 2021, 55 surgical specimens of PSCC were identified. In all cases, thorough morphologic evaluation, HPV DNA detection, and p16, p53, and Ki-67 immunohistochemical (IHC) staining was performed. HPV-independent status was assigned based on both negative results for p16 IHC and HPV DNA. Thirty-six of the 55 PSCC (65%) were HPV-independent. An intraepithelial precursor was identified in 26/36 cases (72%). Five of them (19%) had basaloid features, morphologically indistinguishable from HPV-associated HSIL. The median age of the 5 patients was 74 years (range: 67 to 83 y). All 5 cases were p16 and DNA HPV-negative. Immunohistochemically, 3 cases showed an abnormal p53 pattern, and 2 showed wild-type p53 staining. The associated invasive carcinoma was basaloid in 4 cases and the usual (keratinizing) type in 1. In conclusion, a small proportion of HPV-independent PSCC may arise on adjacent intraepithelial lesions morphologically identical to HPV-associated HSIL. This unusual histologic pattern has not been previously characterized in detail in PSCC. p16 IHC is a valuable tool to identify these lesions and differentiate them from HPV-associated HSIL.

Simultaneous presentation of granulomatosis with polyangiitis (GPA) and immunoglobulin G4-related disease (IgG4-RD). Leaving an open question: widening the spectrum of a single disease or real overlap?

Because of a similar organ involvement and histopathological features, IgG4-related disease (IgG4-RD) may mimic some forms of granulomatosis with polyangiitis (GPA). However, several cases of clear coexistence or overlap of both diseases have been reported. We describe a case of a 47-year-old man presenting with a renal mass and a nasal crusting showing histopathological features of IgG4-RD in both territories. Cytoplasmic/proteinase 3 (PR3) antineutrophil cytoplasmic antibodies (ANCA) were positive and the patient subsequently developed kidney failure and nephritic syndrome that led to a renal biopsy re-evaluation revealing changes compatible with segmental necrotising glomerulonephritis and GPA. Remission induction therapy with prednisone and rituximab was started and clinical and laboratory parameters returned to normal. After administering a maintenance regimen based in rituximab 500 mg every six month the patient remained asymptomatic during 4 years of follow-up and free of prednisone the last 18 months. Although coexistence or overlap of GPA and IgG4-RD may be established in some clinical scenarios, the possibility of widening the spectrum of a single disease is also postulated.

[Potential benefits of living donor kidney transplantation]. / Potenciales beneficios del trasplante renal de donante vivo.

Living donor kidney transplantation is the best therapeutic option for endstage renal failure. In spite of being an underused option in our country, it acquires an important role reducing the waiting lists for transplantation because cadaver donation is not enough. Living donor kidney transplantation offers multiple advantages when compared with cadaver donor transplantation: longer graft and patient survival on the short, mid and long-term; the fact that a scheduled procedure allows us to optimize donor and receptor's conditions; and ischemia time between nephrectomy and transplantation can be shortened to a minimum. A good initial function without need of dialysis (up to 90%) and lower incidence of rejection, which diminishes the need of antirejection drugs, should also be emphasized.

[Surgical evaluation of candidates for donation. Selection of the kidney]. / Estudio del donante desde el punto de vista quirúrgico. Elección del riñón.

Living donation for kidney transplantation is being promoted due to the shortage of organs, the improved outcomes of living donor transplants and the evolution of immunosuppression regimens. The process of organ donation from a living donor affects not only medical-surgical features but also emotional, social and economic. Using kidneys from living donors involves a great responsibility in evaluation and selection. Candidates for donation undergo an extensive set of examinations in order to optimize selection and to plan surgery. Radiological evaluation is one of the most important features of the evaluation process and selection of the kidney; it shows precisely the renal vascular anatomy, which is decisive in the choice of the kidney and helps to optimize the process and diminish risks and complications during extraction and/or tronsplantation. The advantages on imaging tests allow to evaluate potential donors in a safely, fast and almost noninvasive matter. The aim of the process is to select the kidney with less likelihood of failure due to technical reasons, and always leave the best kidney for the donor.