Small renal masses in Latin-American population: characteristics and prognostic factors for survival, recurrence and metastasis - a multi-institutional study from LARCG database.

BACKGROUND: To evaluate demographic, clinical and pathological characteristics of small renal masses (SRM) (≤ 4 cm) in a Latin-American population provided by LARCG (Latin-American Renal Cancer Group) and analyze predictors of survival, recurrence and metastasis. METHODS: A multi-institutional retrospective cohort study of 1523 patients submitted to surgical treatment for non-metastatic SRM from 1979 to 2016. Comparisons between radical (RN) or partial nephrectomy (PN) and young or elderly patients were performed. Kaplan-Meier curves and log-rank tests estimated 10-year overall survival. Predictors of local recurrence or metastasis were analyzed by a multivariable logistic regression model. RESULTS: PN and RN were performed in 897 (66%) and 461 (34%) patients. A proportional increase of PN cases from 48.5% (1979-2009) to 75% (after 2009) was evidenced. Stratifying by age, elderly patients (≥ 65 years) had better 10-year OS rates when submitted to PN (83.5%), than RN (54.5%), p = 0.044. This disparity was not evidenced in younger patients. On multivariable model, bilaterality, extracapsular extension and ASA (American Society of Anesthesiologists) classification ≥3 were predictors of local recurrence. We did not identify significant predictors for distant metastasis in our series. CONCLUSIONS: PN is performed in Latin-America in a similar proportion to developed areas and it has been increasing in the last years. Even in elderly individuals, if good functional status, sufficiently fit to surgery, and favorable tumor characteristics, they should be encouraged to perform PN. Intending to an earlier diagnosis of recurrence or distant metastasis, SRM cases with unfavorable characteristics should have a more rigorous follow-up routine.

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group.

BACKGROUND: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. OBJECTIVE: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥ 75 years of age. METHODS: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (less than 75 vs. ≥75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. RESULTS: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p less than 0.01) and higher ASA score (ASA > 2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p less than 0.01), EBL ≥ 500 cc (OR 3.34, p less than 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. CONCLUSIONS: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities.

[Pain during transrectal ultrasound guided needle biopsy of the prostate: comparison of the use or not of lidocaine gel]. / Dolor durante biopsia de próstata guiada por ultrasonografía transrectal: comparación del uso o no de xilocaína gel como anestésico local.

INTRODUCTION: The prostate biopsy guided by ultrasound is the method of choice for early diagnosis of prostate cancer, is a safe whose main trouble is that it feels discomfort during the procedure. MATERIAL AND METHODS: From July 2004 until March 2005 we prospectively studied 114 patients who underwent transrectal ultrasound guided needle biopsy of the prostate, they were divided in two groups: in one group we used lidocaina gel 2% inside the rectum before the procedure and in the other group we did not use it. We compared the pain that patients felt during the procedure with a pain scale. RESULTS: We did not find differences between both groups, but the patients in whom we used a new needle felt less pain than the patients in whom we used a re-esterilized one. CONCLUSIONS: The use of lidocaine gel intrarectal 2% before a prostate biopsy guided by ultrasound did not diminish the sensation of pain from the procedure in our patients, which was increased by the use of sterilized needles.

[Primary testicular lymphoma: experience at the Instituto Especializado de Enfermedades Neoplásicas, Lima-Peru]. / Linfoma testicular primario: experiencia en el Instituto Nacional de Enfermedades Neoplásicas, Lima-Perú.

INTRODUCTION: Testicular lymphoma is a rare illness with peculiar characteristics but with a poor prognosis. MATERIAL AND METHODS: We evaluated 32 patients retrospectively studying their epidemiologic characteristics, hematologic values, histologic type, metastasis sites, the treatment given and the survival. We compared our results with international reports and we think that prospective studies are needed for better conclusions. RESULTS: The average of age was 45-years-old, with more than the half of patients with clinical stage IV at the moment of the diagnosis, the histiocitic pathology was the most frequent, and the time of survival was 39,543 +/- 14,451 months and the time in which the 50% of the patients die is 15 +/- 7,025 months. CONCLUSIONS: This is a rare disease, with a very poor prognosis, with a time of survival of 39,543 +/- 14,451 months and the time in which the 50% of the patients die is 15 +/- 7,025 months.

Characteristics and Surgical Outcomes in Very Elderly Patients (≥75 years) with Renal Cell Carcinoma: Data from the Latin American Renal Cancer Group

Background: The incidence of renal cell carcinoma (RCC) is increasing globally due to an aging population and widespread use of imaging studies. Objective: The aim of this study was to describe the characteristics and perioperative outcomes of RCC surgery in very elderly patients (VEP), ≥75 years of age. Methods: This is a retrospective comparative study of 3656 patients who underwent the treatment for RCC from 1990 to 2015 in 28 centers from eight Latin American countries. We compared baseline characteristics as well as clinical and perioperative outcomes according to age groups (<75 vs.≥ 75 years). Surgical complications were classified with the Clavien-Dindo score. We performed logistic regression analysis to identify factors associated with perioperative complications. Results: There were 410 VEP patients (11.2%). On bivariate analysis, VEP had a lower body mass index (p < 0.01) and higher ASA score (ASA >2 in 26.3% vs. 12.4%, p < 0.01). There was no difference in performance status and clinical stage between the study groups. There were no differences in surgical margins, estimated blood loss (EBL), complication, and mortality rates (1.3% vs. 0.4%, p = 0.17). On multivariate regression analysis, age ≥75 years (odds ratio [OR] 2.33, p < 0.01), EBL ≥ 500 cc (OR 3.34, p < 0.01), and > pT2 stage (OR 1.63, p = 0.04) were independently associated with perioperative complications. Conclusions: Surgical resection of RCC was safe and successful in VEP. Age ≥75 years was independently associated with 30-day perioperative complications. However, the vast majority were low-grade complications. Age alone should not guide decision-making in these patients, and treatment must be tailored according to performance status and severity of comorbidities. (REV INVEST CLIN. 2020;72(5):308-15)

[Paratesticular mixed sarcoma: liposarcoma-rhabdomyosarcoma. Case report and bibliographic review]. / Sarcoma mixto paratesticular: liposarcoma-rabdomiosarcoma. Presentación de un caso y revisión de la literatura.

OBJECTIVE: Sarcomas arising from the urinary tract are rare, representing less than 2% of all urologic tumors. The paratesticular region is one of the most unfrequent locations. Leiomyosarcoma, rhabdomyo-sarcoma, liposarcoma, malignant fibrohistiocytoma, etc. and the combination of two or more histological types has exceptionally been reported. We describe the case of a patient with a mixed paratesticular sarcoma and perform a bibliographic review. METHODS: The patient underwent right radical orchyectomy and the surgical specimen was sent to pathologic study. RESULTS: There are no previous case reports in the literature of paratesticular mixed tumor with liposarcoma and rhabdomyosarcoma. CONCLUSIONS: Sarcomas of the spermatic cord are rare neoplasias and should be considered on the differential diagnosis of scrotal masses. The treatment of choice is surgical and adjuvant treatment must be individualized depending on tumor aggressiveness.

Dolor durante biopsia de próstata guiada por ultrasonografía transrectal: Comparación del uso o no de Xilocaína gel como anestésico local / Pain during transrectal ultrasound guided needle biopsy Of the prostate: comparison of the use or not of lidocaine Gel

Introducción: La biopsia de próstata guiada por ecografía es el método de elección para el diagnóstico precoz del cáncer de próstata, es un método seguro cuya principal molestia es el disconfort que se siente durante el procedimiento. Material y métodos: Desde julio del 2004 hasta marzo del 2005 se reclutaron 114 pacientes con indicación de biopsia de próstata bajo guía ecográfica los cuales se dividieron en dos grupos según la administración o no de xilocaína gel al 2%intrarrectal antes del procedimiento. Se comparó el dolor que sintieron durante la biopsia a través de una escala de dolor. Resultados: No hubo diferencia estadísticamente significativa entre los pacientes a quienes se administró anestésico local frente a quienes no se les administró. Por otro lado, el dolor fue mayor cuando se usó una aguja esterilizada que cuando se usó una aguja nueva. Conclusiones: El uso de xilocaína gel al 2% intrarrectal previa a la biopsia de próstata guiada por ecografía no disminuyó la sensación de dolor por el procedimiento en nuestros pacientes, el cual fue incrementado por el uso de agujas esterilizadas (AU)

Introduction: The prostate biopsy guided by ultrasound is the method of choice for early diagnosis of prostate cancer, is a safe whose main trouble is that it feels discomfort during the procedure. Material and methods: From July 2004 until March 2005 we prospectively studied 114 patients who underwent transrectal ultrasound guided needle biopsy of the prostate, they were divided in two groups: in one group we used lidocaína gel2% inside the rectum before the procedure and in the other group we did not use it. We compared the pain that patients felt during the procedure with a pain scale. Results: We did not find differences between both groups, but the patients in whom we used a new needle felt less painthan the patients in whom we used a re-esterilized one. Conclusions: The use of lidocaine gel intrarectal 2% before a prostate biopsy guided by ultrasound did not diminish the sensation of pain from the procedure in our patients, which was increased by the use of sterilized needles (AU)

Linfoma testicular primario: experiencia en el Instituto Nacionalde Enfermedades Neoplásicas. Lima-Perú / Primary testicular lymphoma: experience Instituto especializado de enfermedades neoplásicas. Lima-Peru

Introducción: El linfoma testicular es una enfermedad poco frecuente con características peculiares y un pronóstico pobre. Material y métodos: Evaluamos en forma retrospectiva 32 pacientes con este diagnóstico estudiando sus características epidemiológicas, valores hematológicos, tipo histológico, lugares de metástasis, tratamiento recibido y tiempo de sobrevida. Así mismo comparamos nuestros resultados con los reportes internacionales, haciendo énfasis en la necesidad de estudios prospectivos para obtener mejores conclusiones. Resultados: El promedio de edad fue de 45 años, con más de la mitad de los pacientes con estadío clínico IV al momento del diagnóstico, con la variedad histiocítica como la patología más frecuente, y con el tiempo promedio de sobrevida de39,543±14,451 meses, y el tiempo mediano (tiempo en el cual muere el 50% de pacientes) de 15±7,025 meses. Conclusiones: Enfermedad poco frecuente cuyo pronóstico es aún pobre, con una sobrevida promedio de 40 meses y tiempo mediano de 15 meses (AU)

Introduction: Testicular lymphoma is a rare illness with peculiar characteristics but with a poor prognosis. Material and methods: We evaluated 32 patients retrospectively studying their epidemiologic characteristics, hematologic values, histologic type, metastasis sites, the treatment given and the survival. We compared our results with international reports and we think that prospective studies are needed for better conclusions. Results: The average of age was 45 years old, with more than the half of patients with clinical stage IV at the moment of the diagnosis, the histiocitic pathology was the most frequent, and the time of survival was 39,543±14,451 months and the time in which the 50% of the patients die is 15±7,025 months. Conclusions: This is a rare disease, with a very poor prognosis, with a time of survival of 39,543±14,451 months and the time in which the 50% of the patients die is 15±7,025 months (AU)

[Xanthogranulomatous pyelonephritis: clinical, radiological and pathologic characteristics]. / Pielonefritis xantogranulomatosa: características clínicas, radiológicas y anatomo-patológicas.

OBJECTIVES: Xanthogranulomatous pyelonephritis is an atypical chronic infection which simulates a malignant renal neoplasia, definitive diagnosis of which is obtained by pathologic study after surgical removal. In this paper we analyze our experience and compare it to that reported on the literature. METHODS: We performed a retrospective study of cases of xanthogranulomatous pyelonephritis diagnosed in the period from January 1945 to December 2000 at the Institute of Neoplastic Diseases, analyzing clinical, radiological, and surgical features documented in the medical records. RESULTS: There were 11 cases, 82% of them were females. The presence of signs and symptoms such as pain and abdominal mass appeared in 73%, accompanied by hematuria and fever. Most radiological tests showed destruction of the renal parenchyma with abnormalities in the collecting system and obstruction by lithiasis. 91% of the cases had positive urine cultures, being Escherichia coli, Proteus Mirabilis and Klebsiella the most frequent germs. Simple nephrectomy was the surgical treatment, and complications were minimal. CONCLUSIONS: Xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of renal cancer because of its clinical features.

Dolor trans biopsia de próstata guiada por ultrasonografía transrectal: comparación del uso o no de xilocaína gel como anestésico local: Instituto Especializado de Enfermedades Neoplásicas: Lima-Perú 2006 / Pain during transrectal ultrasound guided needle biopsy of the prostate: comparison of the use or not of lidocaine: Instituto Especializado de Enfermedades Neoplásicas: Lima-Perú

Desde julio de 2004 hasta marzo de 2005 se reclutaron 114 pacientes con indicación de biopsia de próstata bajo guía ecográfica los cuales se dividieron en dos grupos según la colocación o no de xilocaína gel al 2 por ciento intrarrectal antes del procedimiento. Se comparó el dolor que sintieron durante la biopsia a través de una escala de dolor. No hubo diferencia estadísticamente significativa entre los pacientes a quienes se colocó anestésico local frente a quienes no se les colocó. Por otro lado, el dolor fue mayor cuando se usó una aguja esterilizada que cuando se usó una aguja nueva.

From July 2004 until March 2005 we prospectively studied 114 patients who underwent transrectal ultrasound guided needle biopsy of the prostate. Patients were divided in two groups: intrarectal 2 percent lidocaine gel was used prior to biopsy in one of the groups. We compared the pain that patients felt during the procedure using a pain scale. We did not find differences between both groups, but the patients in whom we used a new needle felt less pain than the patients in whom we used a reesterilized one.

Sarcoma mixto paratesticular: liposarcoma - rabdomiosarcoma. Presentación de un caso y revisión de la literatura / Paratesticular mixed sarcoma: liposarcoma-rhabdomyosarcoma. Case report and bibliographic review

OBJETIVO: Los sarcomas que se originan en el tracto urinario son raros, representando menos del 2% de los tumores urológicos, siendo las de localización paratesticular menos frecuentes. Se describen casos de leiomiosarcoma, rabdomiosarcoma, liposarcoma, fibrohistiocitoma maligno, y otros. La combinación de dos o más variedades en un mismo tumor han sido reportadas excepcionalmente. Describimos el caso de un paciente con sarcoma mixto paratesticular y realizamos la revisión de la literatura. MÉTODOS: El paciente fue sometido a orquiectomía radical derecha y la pieza operatoria enviada a estudio anátomopatológico. RESULTADOS: No se reportan casos similares de presentación de un tumor paratesticular mixto con componentes de liposarcoma y rabdomiosarcoma. CONCLUSIONES: Los sarcomas del cordón espermático son neoplasias raras que deben ser sospechadas en el enfoque diagnóstico de las masas escrotales. Su manejo inicial es quirúrgico y el tratamiento complementario debe considerarse de forma individualizada en razón de la agresividad de este tumor (AU)

OBJECTIVE: Sarcomas arising from the urinary tract are rare, representing less than 2% of all urologic tumors. The paratesticular region is one of the most unfrequent locations. Leiomyosarcoma, rhabdomyosarcoma, liposarcoma, malignant fibrohistiocytoma, etc. and the combination of two or more histological types has exceptionally been reported . We describe the case of a patient with a mixed paratesticular sarcoma and perform a bibliographic review. METHODS: The patient underwent right radical orchyectomy and the surgical specimen was sent to pathologic study. RESULTS: There are no previous case reports in the literature of paratesticular mixed tumor with liposarcoma and rhabdomyosarcoma. CONCLUSIONS: Sarcomas of the spermatic cord are rare neoplasias and should be considered on the differential diagnosis of scrotal masses. The treatment of choice is surgical and adjuvant treatment must be individualized depending on tumor aggressiveness (AU)

Las instilaciones endovesicales en la terapia del cáncer superficial de la vejiga / I manage of the armpit in cancer of suckles precocious: controversies

Las instalaciones endovesicales representan el más importante progreso en la terapia intravesical de los tumores de la vejiga en los últimos 20 años. esta terapia intravesical puede ser divida en quimioterapia (QT) e inmunoterapia (IT). La QT endovesical disminuye significativamente el riesgo de recurrencia. la inmunoterapia (IT) con BCG (instilaciones endovesicales de bacilo Camette-Guerin), disminuyen significativamente el riesgo de recidiva y de progresión. Estas instilaciones pueden estar asociada a un cierto número de complicaciones graves, que aunque raras merecen identificación temprana y tratamiento adecuado. es importante conocer la exacta indicación y contraindicaciones de su uso, como una forma de prevenir eventuales complicaciones y de vigilar atentamente su tolerancia y eficacia.

Pielonefritis xantogranulomatosa: características clínicas, radiológicas y anatomo-patológicas / Xanthogranulomatous pyelonephritis: clinical, radiological and pathologic characteristics

OBJETIVOS: La pielonefritis xantogranulomatosa es una infección crónica atípica que simula una neoplasia renal maligna y cuyo diagnóstico definitivo se obtiene del estudio anatomopatológico posterior a la resección quirúrgica. En el presente trabajo analizamos y comparamos nuestra experiencia con lo reportado en la literatura. MÉTODOS: Se realizó un estudio retrospectivo de los casos de pielonefritis xantogranulomatosa diagnosticados en el periodo comprendido de Enero de 1945 a Diciembre del 2000 en el Instituto de Enfermedades Neoplásicas, analizando los aspectos clínicos, radiológicos y quirúrgicos registrados en las historias clínicas. RESULTADOS: Se obtuvieron 11 casos de los cuales el 82 por ciento se presentaron en mujeres. La presencia de signos y síntomas como dolor y masa abdominal se presentó en un 73 por ciento, acompañados de hematuria y alza térmica. Las pruebas radiológicas describieron en su mayoría la destrucción del parénquima renal con alteraciones en el sistema colector y obstrucción del mismo por litiasis. El cultivo positivo de orina fue predominante en el estudio en un 91 por ciento de los casos, teniendo a Escherichia coli, Proteus mirabilis y Klebsiella como gérmenes más frecuentes. El tratamiento quirúrgico fue la nefrectomía simple y las complicaciones que se presentaron fueron mínimas. CONCLUSIONES: La pielonefritis xantogranolomatosa, por sus manifestaciones clínicas, debe considerarse en el diagnóstico diferencial del cáncer renal (AU)

Leiomiosarcoma de vena renal. A propósito de un caso y revisión de la literatura / Leiomyosarcoma of renal vein. About a case and review of the literature

Los leiomiosarcomas de origen vascular son una patología rara y agresiva, siendo poco frecuente la presentación a nivel de la vena renal; reportándose 29 casos a nivel mundial. Describimos un caso de una mujer de 76 años, quien presentó 6 meses de dolor intermitente en flanco izquierdo, irradiado a región lumbar. Se realizó nefrectomía radical con resección en bloque de tumor para-aórtico. El examen microscópico de la pieza operatoria reportó leiomiosarcomas moderadamente diferenciado, originado en la pared de la vena renal. Recibió tratamiento adyuvante con quimioterapia y radioterapia. El tumor recurrió a nivel hepático. Luego de 24 meses de la primera cirugía, el paciente esta vivo con evidencia de múltiples metástasis a nivel hepático. Ella se encuentra actualmente bajo cuidado paliativo.