Rectal cancer threatening or affecting the prostatic plane: is partial prostatectomy oncologically adequate? Results of a multicentre retrospective study.

AIM: The management of rectal cancer threatening or affecting the prostatic plane is still under debate. The role of preoperative chemo radiotherapy and the extent of prostatectomy seem to be key points in the treatment of these tumours. The aim of the present study was to evaluate the pathological circumferential margin status and the local recurrence rate following different therapeutic options. METHOD: A multicentre, retrospective study was conducted of patients with rectal cancer threatening or affecting the prostatic plane, but not the bladder, judged by magnetic resonance imaging (MRI). The use of preoperative chemoradiotherapy and the type of urologic resection were correlated with the status of the pathological circumferential resection margin (CRM) and local recurrence. RESULTS: A consecutive series of 126 men with rectal cancer threatening (44) or affecting (82) the prostatic plane on preoperative staging and operated with local curative intent between 1998 and 2010 was analysed. In patients who did not have chemoradiotherapy but had a preoperative threatened anterior margin the CRM-positive rate was 25.0%. In patients who did not have preoperative chemoradiotherapy but did have an affected margin, the CRM-positive rate was 41.7%. When preoperative radiotherapy was given, the respective CRM infiltration rates were 7.1 and 20.7%. In patients having preoperative chemoradiotherapy followed by prostatic resection the rate of CRM positivity was 2.4%. Partial prostatectomy after preoperative chemoradiotherapy resulted in a free anterior CRM in all cases, but intra-operative urethral damage occurred in 36.4% of patients who underwent partial prostatectomy, resulting in a postoperative urinary fistula in 18.2% of patients. CONCLUSION: Preoperative chemoradiation is mandatory in male patients with a threatened or affected anterior circumferential margin on preoperative MRI. In patients with preoperative prostatic infiltration, prostatic resection is necessary. In this group of patients partial prostatectomy seems to be oncologically safe.

[Inflammatory pseudotumor of the spleen]. / Seudotumor inflamatorio de bazo.

A case of inflammatory pseudotumor of the spleen in a 69-year-old woman who was studied for elevated globular sedimentation rate is presented. The lesion was observed on echography as a mixed solid-cystic mass. Magnetic resonance showed a slight decrease in signal intensity in potentiated T1 sequences and a heterogenic mass with high signal areas in T2 images and protonic density. Splenectomy was performed and histopathologic study demonstrated an inflammatory pseudotumor of 10 cm in its greatest size. Two year follow up was satisfactory. On review of the literature only 34 cases of inflammatory pseudotumors have been previously published. Half of the cases presented during the 6th and 7th decades of life, with women being the most frequently affected. Inflammatory pseudotumors of the spleen are benign lesions which should be considered in the differential diagnosis of splenic masses. Since diagnosis cannot be made preoperatively, and a malignant tumor is almost always suspected, splenectomy should be performed.

[Isolated primary hyperaldosteronism caused by adrenocortical carcinoma]. / Hiperaldosteronismo primario aislado causado por carcinoma córtico-suprarrenal.

OBJECTIVE: To report a case of adrenocortical carcinoma and primary aldosteronism as the sole endocrine manifestation. METHODS/RESULTS: A 39-year-old male with adrenocortical carcinoma and primary aldosteronism is presented. Following complete hormonal and radiological evaluation, right adrenalectomy and nephrectomy were performed (pT2pN0M0, stage II). Blood pressure, serum potassium and aldosterone levels returned to normal. The patient received adjuvant therapy with carboplatin and etoposide. After 15 months' disease-free interval, lung metastasis was diagnosed, without evidence of local recurrence until 5 months later, when hypertension and primary hyperaldosteronism reappeared. There were no other endocrine disorders. Treatment with spironolactone, 5-FU and adriamycin was instituted with no tumor response and the patient died 3 years later from complications of endobronchial metastasis. CONCLUSION: Adrenocortical carcinoma with isolated primary hyperaldosteronism is uncommon and consequently there is no wide experience in regard to its diagnosis and treatment. Although randomized studies are not available, adjuvant therapy using other agents instead of mitotane (o,p-DDD), such as the combination of cisplatin and etoposide (VP-16), seems reasonable in the locally advanced stages. Mitotane may be useful when hypercortisolism is present, but its efficacy as an antitumor agent has been controversial.

[Magnetic resonance in the evaluation of neurologic complications of cervical spondylosis]. / La resonancia magnética en la evaluación de las complicaciones neurológicas de la espondilosis cervical.

The evaluation of the neurological complications of cervical spondylosis frequently requires contrast myelography. Magnetic resonance (MR) scan would appear as a good alternative approach. We report the MR findings in 12 patients with symptoms and/or signs of spinal cord and radicular disease associated with cervical spondylosis, and we compare them with the conventional studies, including CT and CT assisted myelography. The MR image, weighted in T1, permitted to visualize the compressed spinal cord in the sagittal planes in 4 cases, with enhanced spinal cord signal in 2 of them. In a patient with herniated C5-C6 disk, the sagittal sections directly demonstrated the herniated material in the spinal canal, displacing and compressing the spinal cord. The sequences weighted in T2 demonstrated the degree of stenosis of the cervical canal caused by extradural compression. In these images, the diminished signal of the nucleus pulposus was correlated with degeneration of intervertebral disks. MR was more sensitive than the other studies to detect discal degeneration and herniation, stenosis of the spinal canal, compression of the subarachnoidal space and spinal cord injury.