Microbladder due to Granulomatous Cystitis Secondary to BCG Treatment.

INTRODUCTION: Intravesical immunotherapy with bacillus Calmette-Guerin (BCG) is considered as the standard treatment for non-muscle invasive bladder cancer with high risk of recurrence and progression. OBJECTIVE: To report a case of granulomatous cystitis in a patient receiving BCG intravesical therapy for urothelial carcinoma. MATERIAL AND METHODS: A 63-year-old man underwent BCG treatment for a bladder tumor with pathological diagnosis of T1G3 urothelial carcinoma. Five months later, trans urethral resection (TUR) of bladder was performed for an erythematous lesion, with results of post-BCG cystitis. Two years later, the patient presented with hematuria and with suspicious findings in the cystoscopy (extensive fibrin-covered and calcified lesions in the bladder) and a bladder TUR was done. RESULTS: The histopathological study showed granulomatous cystitis with necrosis and the presence of BAAR compatible with post-BCG origin. In the mycobacterial culture, M. bovis grew, and treatment was initiated. A cystography was performed on suspicion of a microbladder on CT with secondary vesicoureteral reflux, confirmed in this test. It was decided to perform a radical cystectomy. Histopathology reported post-BCG granulomatous cystitis and prostatitis. CONCLUSIONS: After BCG treatment, if symptoms or images are suggestive of granulomatous cystitis, a study of mycobacterial infection should be started to avoid the development of complications, such as the microbladder as in the case we present.

[Penile Cancer: A case for non-lymph node disease following a negative sentinel node exploration.] / Cáncer de pene: afectación extranodal en paciente con ganglio centinela negativo.

OBJECTIVE: To describe the case of a patient with subcutaneous inguinal recurrence of penile cancer without lymph node involvement. METHODS: Description of a clinical case and review of the literature on the subject. RESULTS: We present the case of a 72-year-old man with penile cancer and extranodal inguinal extension that affected subcutaneous cell tissue, with a history of negative sentinel lymph node and subsequently without invasion of the regional lymph nodes in lymphadenectomy after chemotherapy. The patient presented disease progression despite multimodal treatment. CONCLUSION: Extranodal inguinal involvement in penile cancer may occur despite a history of negative sentinel lymph node. The evolution of the patient we presented was disastrous despite the multimodal treatment carried out.

OBJETIVO: Describir el caso de un paciente con recurrencia inguinal subcutánea de cáncer de pene sin afectación ganglionar. MÉTODOS: Descripción de un caso clínico y revisión de la literatura sobre el tema. RESULTADOS: Presentamos el caso de un hombre de 72 años con cáncer de pene y extensión inguinal extranodal que afectó al tejido celular subcutáneo, con antecedente de ganglio centinelal negativo y posteriormente sin invasión de los ganglios linfáticos regionales en linfadenectomía tras quimioterapia. El paciente presentó progresión de enfermedad a pesar de un tratamiento multimodal. CONCLUSIÓN: La afectación extraganglionar inguinal en cáncer de pene puede producirse a pesar de un antecedente de ganglio centinela negativo para neoplasia. La evolución del paciente que presentamos fue nefasta a pesar del tratamiento multimodal llevado a cabo.

Embarazo ectópico intersticial tratado con metotrexato y cirugía: caso clínico / Interstitial ectopic pregnancy treated with methotrexate and surgery: clinical case

RESUMEN Antecedentes: El embarazo intersticial es muy inusual y representa <2,4% de todos las gestaciones ectópicas. Objetivo: Se presenta el caso de un embarazo ectópico intersticial tratado de forma médica y quirúrgica. Se realiza una revisión literaria sobre las opciones de manejo y tratamiento. Caso clínico: Paciente primigesta de 36 años con gestación ectópica cornual derecha tras 11 días de la transferencia de un embrión criopreservado. Se decide tratamiento con metotrexato (MTX) sin éxito y con progresión del embarazo, obligándonos por lo tanto a realizar una evacuación quirúrgica de la gestación, exponiendo a la paciente tanto a los efectos secundarios del tratamiento médico como a los del abordaje quirúrgico. Conclusión: El embarazo ectópico intersticial sigue siendo un reto para el ginecólogo. El diagnóstico muy temprano de estas patologías, aunque difícil, podría evitar la opción quirúrgica, siendo el MTX más eficaz en los casos tratados precozmente.

ABSTRACT Background: Interstitial pregnancy is very unusual, and it represents <2,4% of all ectopic pregnancies. Objective: We present the case of an interstitial ectopic pregnancy treated medically and surgically. A literary review is also made about the management and treatment options. Clinical case: A 36-year-old patient with a diagnosis of right cornual ectopic pregnancy after 11 days of a cryopreserved embryo's transfer. Methotrexate (MTX) treatment was applied as the initial step but without lasting results. Because of the progression of the pregnancy, further therapy was focused on its surgical evacuation exposing the patient to the side effects of both medical treatment and surgical approach. Conclusion: Interstitial ectopic pregnancy remains a challenge for the gynecologist. Very early diagnosis of these pathologies, although difficult, could avoid the surgical outcome, being MTX more effective in cases intervened initially.