[Bilateral femoral neuropathy after prostatectomy. Case report and bibliographic review]. / Neuropatía femoral bilateral tras prostatectomía. Presentación de un caso y revisión del tema.

OBJECTIVE: To report one case of postoperative lateral femoral neuropathy presenting after a retropubic radical prostatectomy. We review the topic. METHODS: We describe the case of a 72-year-old patient undergoing radical prostatectomy. Combined anesthesia, general and spinal, was given. A self-retaining automatic retractor (Omnitract) was employed. In the immediate postoperative period the patient presented bilateral femoral neuropathy, with difficulties for knees extension and hips flexion, diminished patellar reflex, and absence of sensitivity in the anterior area of the thighs. MRI was performed to rule out spinal pathology. RESULTS: The symptoms improved a lot within a week, completely recovering after two months. CONCLUSIONS: Femoral neuropathy is a rare complication after pelvic surgery. In our case we believe it was secondary to nerve compression by the retractor.

[Spontaneous rupture of a simple renal cyst to the pyelocalyceal system. Evolution from Bosniak I to IIF]. / Ruptura espontánea de quiste renal simple en el sistema pielocalicial. Evolución desde Bosniak I a IIF.

OBJECTIVE: To report the spontaneous rupture of a renal cyst into the adjacent pyelocalyceal collecting system. METHODS: We present the case of a 47 year old woman with a 17 centimeter simple renal cyst (Bosniak I) as well as ipsilateral nephrolithiasis. The patient had a febrile urinary tract infection with flank pain. A subsequent CT scan revealed that this cyst spontaneously ruptured into the renal pelvis. RESULTS: Follow up evaluations showed the former cyst has decreased in size and contain thick and nodular calcifications. At present it is a Bosniak IIF cyst. CONCLUSION: Simple renal cysts can spontaneously rupture and drain into the adjacent renal collecting system.

[Inflammatory prostatic pseudotumor (fibromyxoid pseudosarcomatous tumor)]. / Pseudotumor inflamatorio de prostata (tumor fibromixoide pseudosarcomatoso).

OBJECTIVES: To report one case of an exceptional benign prostatic pathology and its differential diagnosis with malignant tumors. METHODS: 67-year-old male who suffers an acute urinary retention requiring bladder catheterization and subsequent negative catheter removal tests. Digital rectal examination showed a small prostate, adenomatous, without nodules. PSA was 1.01 ng/ml. The patient underwent transurethral resection of the prostate because of the persistence of urinary retention. RESULTS: Pathologic study reported a hypercellular stroma, with a perivascularly distributed inflammatory infiltrate and myxoid stromal background with slightly atypical fusiform cells. Immunohistochemical studies showed positive staining of fusiform cells for vimentin and histiocytes in the lesion for CD68, and negative staining for cytokeratin. The final diagnosis was prostatic inflammatory pseudotumor. CONCLUSIONS: In spite of being an unfrequent presentation it is important to take this benign lesion under consideration to avoid unnecessary aggressive radical complementary treatments.

[Pneumopyocystitis in a patient with adult polycystic kidney disease]. / Pioneumoquistes en paciente con enfermedad poliquística del adulto.

OBJECTIVES: We present a case of adult polycystic kidney disease, also known as autosomal dominant polycystic kidney, complicated by infection of the cysts and the formation of gas within them. METHODS/RESULTS: A 59 year old patient diagnosed of adult polycystic kidney disease with chronic renal failure on treatment with haemodialysis, who presented sepsis secondary to infection of the renal cysts. The CT scan demonstrated the presence of gas within the cysts and the microbiology revealed E. coli in one of them. Urgent nephrectomy was performed. A histological specimen of the excised organ is also presented. CONCLUSIONS: Infection of one or more cysts in adult polycystic kidney disease is a rare and serious complication which may require immediate nephrectomy, particularly if gas appears within the cysts.

[Fulminant hepatic insufficiency caused by diffuse intrasinusoidal liver metastases in a patient with transitional-cell carcinoma of the bladder]. / Insuficiencia hepática fulminante por metástasis hepática intrasinusoidal difusa en un paciente con carcinoma transicional de vejiga.

OBJECTIVE: To present a case of transitional cell carcinoma of the bladder with diffuse intrasinusoidal metastases to the liver that presented as fulminant hepatic failure. METHODS/RESULTS: A 65-year-old patient who presented at the emergency department of this hospital with fever and pain in the right hypochondrium and flank is described. Three months previously the patient had undergone operation in our department for a recurrence of a tumor affecting the bladder and urethra (Tis of the bladder and T1 GII of the prostatic urethra). The blood tests on admission were practically normal but showed alterations from the twelfth day onwards, suggesting acute liver failure in the differential diagnosis; the patient died 21 days later. The ultrasound and CT scans showed hepatomegaly with multiple heterogeneous areas which were not visible three months earlier and with no space-occupying lesions. At autopsy, the liver was found to be enlarged, with no macroscopic metastatic nodules. Microscopic examination revealed massive tumoral infiltration of the hepatic sinusoids with diffuse replacement of the hepatocytes. CONCLUSIONS: Secondary, metastatic liver cancer usually presents as multiple nodular lesions and only vary on very rare occasions as a diffuse infiltration leading to acute hepatic failure. This case provides the first description of the autopsy findings in a bladder transitional cell carcinoma with diffuse intrasinusoidal metastases to the liver.