[Priapism secondary to penis infiltration of bladder cancer]. / Priapismo secundario a infiltración peneana por contigüidad de carcinoma vesical infiltrante.

Metastasic priapism is a rare entity produced by tumor cell implantation or direct infiltration of corpora cavernousum of the penis. In up to 80% of cases the primary tumor has an urological origen like prostate or bladder cancers. Treatment depends on syntomatology and patient's prognosis. Generally, average survival in these patients is poor due to metastasic progression, among 1 to 1 and a half years. We present a case report of secondary priapism for direct invasion of the corpora cavernousum of the penis for bladder carcinoma.

[Adenomatoid tumour of epididymis: the most common tumour of the paratesticular structures]. / Tumor adenomatoide de epididimo: el tumor más frecuente de las estructuras paratesticulares.

INTRODUCTION: Paratesticular tumours are rare but generally benign neoplasms, usually treated by local excission. Adenomatoid tumours of epididymis are the most common of these tumours. OBJECTIVES: Analyze paratesticular tumours treated in our center and describe dyagnosis and treatment of adenomatoid tumours of epididymis. MATERIAL AND METHODS: We retrospectively review 8 patients with paratesticular tumours treated from July 1997 to July 2007. We analyze clinical presentation, dyagnostic suspicion given by image technique, treatment followed and final dyagnosis. RESULTS: Patients median age was 44.1 years (22-69), presenting most of them subacute scrotal tumour with median size by ultrasound of 2.8 cm (1.5-7). All of them were locally extirpated except one with suspicion of a malignant polyorchidism and another one with an apparently intratesticular lesion of great size. Just in two cases peroperatory biopsy was performed. Dyagnosis was in 4 cases adenomatoid tumour of epididymis, in two cases fibrous pseudotumour of epididymis, in one case leiomyoma of epididymis and in one case angiolipoma of spermatic cord. Just in one case diagnosed of adenomatoid tumour of epididymis ultrasound confirmed solid tumour suggesting the final dyagnosis. CONCLUSIONS: Adenomatoid tumors of epididymis are rare tumours which may present at any age. Ultrasound may help in dyagnosis, but its capacity to distinguish this lesions is low. Benignity of adenomatoid tumour of epididymis as well as most of the other paratesticular tumours should make local excission the treatment of choice and, when any doubt existed, peroperatory biopsy should be performed.

[Prognosis and predictive factors of prostate cancer in the prostatic biopsy]. / Factores pronósticos y predictivos del carcinoma de próstata en la biopsia prostática.

This paper reviews the morphological cancer diagnosis criteria on needle biopsies, the predictive meaning of the pathological lesions of HGPIN, HAA, and P.I.A and the peculiar histopathological patterns in prostatic adenocarcinoma. We present the histological parameters that the pathologist has to informe in the diagnositic, on the routine prostate needle biopsy: Gleason histological degree, histological type, number of invaded cilindres, percentage of tumor in each cylinder, location of the biopsy and ymphovascular invasion. We also emphasize the importance of new predictive biomarkers nowadays in study and probably involved in tumor progression.

[Iron deficiency: not always blood losses]. / Ferropenia: no siempre son pérdidas.

UNLABELLED: Iron deficiency may be the only presenting sign of malabsorption due to the presence of intestinal villous atrophy. Once gastrointestinal blood losses have been excluded, intestinal malabsorption should be investigated. OBJECTIVES: To determine the utility of jejunal biopsy in the evaluation of iron deficiency due to a defective absorption and the different diseases that may cause malabsortive iron deficiency. METHODS: Seventy patients with iron deficiency (ferritin<25 ng/ml), referred to the Unitat de Proves Funcionals Digestives to perform a jejunal biopsy were included. Jejunal biopsy was obtained distal to Treitz with a Watson capsule. Histological changes were classified according to the criteria proposed by Marsh. RESULTS: Jejunal biopsy was performed in 66 patients. Histology was normal in 25, unespecific in 1, showed inflammatory infiltrate in 12, hyperplastic changes in 2 and atrophy in 25. In one patient showed intestinal giardiasis. The clinical diagnosis was celiac sprue in 21 patients (32%), aclorhydria in 7 (10.5%), bacterial overgrowth in 1 (1.5%), intestinal giardiasis in 1 (1.5%), menstrual blood loss in 1 (1.5%) and 35(53%) patients remained without a definitive diagnosis. CONCLUSIONS: Jejunal biopsy is useful in the evaluation of iron deficiency due to intestinal malabsorption and reveals intestinal abnormalities in a significant number of cases.

[Primary lymphoma of the prostate: report of a clinico-pathological case and review of the literature]. / Linfoma primario de próstata: presentación de un caso clínico-patológico y revisión de la literatura.

Lymphoma involving the prostate is rare, wether presenting as primary extranodal lymphoma or as a secondary spread to the prostate from other sites. There are less than 100 cases reported in the literature and accounts for 0.09-0.1%. The clinical presentation can be attributed to nodular hyperplasia or prostatic carcinoma. Criteria for primary prostatic lymphoma include: 1) tumor limited to the prostate and adjacent soft tissues. 2) the absence of lymph node involvement. 3) a lymphoma free interval of at least 1 month. The evolution is rapid and the prognosis remains poor regardless of the patient age, histologic type, treatment, or clinical stage of disease at presentation. We report a case of a 65 years old male in which the incidental diagnosis of lymphoma of the prostate was performed in the adenomectomy. The clinico-pathological criteria and the histogenesis of this entity are described.

[The clinical usefulness of routine biopsy of the transition zone in the diagnosis of prostate cancer]. / Utilidad clínica de la biopsia rutinaria de la zona transicional en el diagnóstico del cáncer de próstata.

OBJECTIVE: To evaluate the effectiveness of routine biopsy of the transitional area in patients undergoing early systematic sextant biopsy. PATIENTS AND METHODS: Two biopsies were taken from the transitional area further to a sextant biopsy in 164 consecutive patients. 98 cases had serum PSA levels higher than 4 ng/mL and 66 suspicious rectal digital examination. RESULTS: Cancer was detected in 77 patients (46.9%). In 28 (36.4%) cases cancer was found only in the peripheral area, in 2 (2.6%) in the transitional area and in 47 (61%) in both areas. CONCLUSION: Routine biopsy of the transitional area in early systematic prostate biopsy appears to be little effective. This would probably be indicated for patients undergoing rebiopsy.

[The incidence of lesions associated with prostatic biopsy and its effect on the serum concentration of the prostate-specific antigen]. / Incidencia de lesiones asociadas en la biopsia prostática y su influencia en la concentración sérica del antígeno prostático específico.

OBJECTIVE: To analyze the incidence of pathoanatomical lesions seen in systematic prostate biopsies and to evaluate their influence on PSA serum levels. MATERIAL AND METHODS: 495 consecutive prostate biopsies, indicated by a suspicion digital rectal examination in 194 patients (39.2%) and raised serum PSA in 301 (60.8%), were evaluated. Biopsy was performed by sextant and hypoechoic nodes, and PSA serum measurements by dual monoclonal antibody radioimmunoassay, Tandem PSA. RESULTS: Cancer was diagnosed in 42.6% biopsies and BPH in 67.4%; additionally, other associated lesions were detected in 74.6% cases, the most frequent ones being chronic prostatitis (47.3%), glandular atrophy (35.9%) and acute prostatitis (23%). All lesions were significantly related to the primary BPH diagnosis in 74.2% to 85% cases. High grade PIN (14.1%) was related to primary cancer diagnosis in 87.1% cases. The multivariate analysis showed that the main diagnosis (BPH vs cancer) was the only variable that had a significant influence on PSA serum levels. When BPH patients were considered separately, the only variable with significant influence on PSA serum levels was the prostatic volume. The univariate analysis showed a nonsignificant increase in association with acute prostatitis and high grade PIN, and a decrease in association with chronic prostatitis. CONCLUSIONS: BPH or cancer associated damage is very frequent in prostatic biopsies. However, the only factors showing a significant contribution to PSA serum levels appear to be the presence or absence of cancer, or the prostatic volume when the main diagnosis is BPH.

[Analysis of free PSA percentage predicting potential surgical failure in patients treated with radical prostatectomy]. / Análisis del porcentaje de PSA libre en la predicción del fallo quirúrgico potencial en pacientes sometidos a prostatectomía radical.

OBJECTIVE: To analyze if free PSA percentage can help to predict a potential surgical failure (PSF) in patients undergoing radical prostatectomy. MATERIAL AND METHODS: Analysis of serum PSA concentration and free PSA percentage in 92 patients undergoing retropubic radical prostatectomy. In 38 cases, the carcinoma was organ-confined, 26 had capsule penetration, 20 had positive margins, 6 seminal vesicle invasion and 2 lymph nodes. PSF was demonstrated in 28 patients (30.4%) and in 64 (69.6%) the carcinoma was organ-confined. RESULTS: No significant relationship was found between PSA serum concentration or free PSA percentage to the pathological stage. The logistic regression analysis where the clinical status, Gleason sum, and free PSA percentage were included as predictive variables, showed that the latter was the only factor with capacity for PSF prediction. Over all, the probability of a carcinoma being confined in the surgical specimen when percentage of free PSA was greater than 10 was 83.8% and 60% when it was lower or equal, p < 0.03. However, the distribution was only significant when PSA concentration ranged between 4.1 and 10 ng/mL, p < 0.008. In this range of PSA, the relative risk of PSF was 5.5 (95% CI 1.4-21.8) when free PSA percentage was equal or lower than 10, the probability being 50% versus 9.1% when it was greater than 10. CONCLUSIONS: Free PSA percentage can help to predict PSF. PSA serum concentration lower than 10 ng/mL and free PSA percentage greater than 10 allows to detect a subgroup of patients with good prognosis and with less than 10% probability of having positive margins, seminal vesicles invasion or lymph nodes.

[Current status of p53 tumor suppressor gene as a possible molecular marker of cancer of the prostate]. / Estado actual del gen supresor de tumor p53 como posible marcador molecular del cáncer de próstata.

Diagnosis of prostate cancer has increased over the last few years both in localized and in more advanced stages. At present, several groups are working in the search and evaluation of alternative tumoral markers as the current ones do not cover all the Urologist's needs. In this context, a number of studies on the mutation of the tumour suppressor gen p53 in both localized and metastatic prostate cancer are being carried out. When a noxa acts on the DNA, protein p53 inhibits the cell cycle allowing the repair systems to operate and, if the damage is significant enough, cell apoptosis. The loss of this control mechanism secondary to the synthesis of anomalous proteins can result in the proliferation of neoplastic cells. A revision of the most representative papers in the literature is presented here, addressing the surrounding controversy and the resulting future possibilities.

[Vesical endometriosis. Report of a case with immunohistochemical study]. / Endometriosis vesical. Presentación de un caso con estudio inmunohistoquímico.

OBJECTIVE: To analyze the hormonal dependence of estrogen and progesterone receptors in endometriosis of the bladder. METHODS: A case of endometriosis of the bladder that had presented as a tumor in a 30-year-old female is described. Immunohistochemical studies were performed using estrogen and progesterone antireceptor antibodies. RESULTS: A strong positivity for progesterone in the endometriotic stromal cells was demonstrated. A mild positivity for estrogen in the glandular epithelial and stromal cells was observed. CONCLUSIONS: The present case demonstrates the hormonal dependence of endometriosis of the bladder and raises the possibility of utilizing hormone therapy in specific patients.

[Polypoid cystitis, isolated lesion with a unique presentation]. / Cistitis polipoide, lesión única de presentación singular.

OBJECTIVES: To report on an uncommon case of polypoid cystitis. METHODS/RESULTS: The patient had consulted because urinary stream was suddenly interrupted due to a mass protruding into the urethral meatus. The US, IVP, cystoscopic and pathological findings are documented. The literature on polypoid cystitis is briefly reviewed with special reference to its forms of presentation and the pathological findings which permit making the differential diagnosis from other pathologies, the most important being transitional cell papillary carcinoma. CONCLUSIONS: An uncommon case of cystitis is described, which emphasizes the varied forms of presentation of this condition and the need to distinguish this lesion from other pathologies, particularly bladder carcinoma.

[Two new Leydig cell testicular tumors presenting with gynecomastia in adults]. / Dos nuevos tumores testiculares de células de Leydig en el adulto que debutan con ginecomastia.

Presentation of two cases of Leydig cell tumor in adult patients who presented with gynecomastia, and slightly abnormal hormonal profiles. One patient had a non palpable tumor. The pathophysiology of this entity is commented, as well as the importance of the different modalities in its diagnosis.

[Primary signet ring cell adenocarcinoma of the bladder. Report of 2 cases of bladder plastic linitis]. / Adenocarcinoma de células en anillo de sello primario de vejiga. Presentación de dos casos de linitis plástica vesical.

OBJECTIVES: Two additional cases of signet-ring cell adenocarcinoma of the urinary bladder, an uncommon highly malignant tumor type, are described. METHODS/RESULTS: The clinical features, histopathological findings and immunohistochemical study are presented. CONCLUSIONS: Both cases previously had cystic glandular cystitis, which supports the totipotent urothelium origin of this neoplasm. Signet-ring cell adenocarcinoma or linitis plastica of the bladder has a highly malignant course despite neoadjuvant chemotherapy and total cystectomy.

[Adenocarcinoma in addition to bladder exstrophy. Apropos a case and a review of the literature]. / Adenocarcinoma sobre extrofia vesical. A propósito de un caso y revisión de la literatura.

Herein we describe a case of adenocarcinoma complicating exstrophy of the bladder in a 59-year-old patient. The morphologic, histochemical and immunohistochemical analyses revealed a colonic glandular adenocarcinoma. The two hypotheses relative to its pathogenesis are briefly discussed. To date, 106 cases have been reported in the literature.

[Bladder inverted papilloma. Can it be considered as a neoplasm with low degree of malignancy?]. / Papiloma invertido vesical. Se puede considerar una neoplasia de bajo grado de malignidad?

We report a case of inverted papilloma of the bladder. The clinical features, diagnosis and treatment of this tumor type are discussed. We underscore the histology and histogenesis of the two types: trabecular inverted papilloma and glandular inverted papilloma. A review of the literature has shown that inverted papillomas do not show clinical or histological features of malignancy most of the time. The cases with synchronous or metachronous association with transitional cell carcinoma, recurrence or histologic signs of malignant transformation of a lesion may be considered to have a neoplasm of low grade malignancy and these patients must be followed closely.

[Bladder sarcomatoid carcinoma: report of a case]. / Carcinoma sarcomatoide vesical: a propósito de un caso.

A case of sarcomatoid carcinoma of the bladder is described. Its interest basically stems from the fact that this extremely aggressive tumor is uncommon in the bladder and there is existing controversy as to its anatomopathological distinction from other carcinosarcomas, spindle cell sarcoma and pseudosarcomatous bladder lesions.

[A clinically unsuspected pheochromocytoma]. / Feocromocitoma clínicamente insospechado.

Pheochromocytomas are often unnoticed, and diagnosis is performed on autopsy examination, or more rarely it is noticed during surgery or abdominal exam for a different reason. In many of these patients the lack of hypertension is a characteristic feature. We contribute a singular case of a patient with pheochromocytoma found by chance during an abdominal exam and which in spite of secreting noradrenaline, did not provoke hypertension or other symptoms. We review literature on this stage form of presentation and the different physio-pharmacological hypothesis which could condition the absence of clinical manifestations. We discuss the preoperative management in patients without hypertension.

[A little known entity: aggressive fibromatosis]. / Una entidad poco estudiada: la fibromatosis agresiva.

Aggressive fibromatosis is an unfrequent and little known entity, which in spite of being a histologically benign tumoration with scarce mitosis and without metastasis at distance, frequently presents with a high degree of local malignancy that can cause serious functional and aesthetical disturbance for the patient and even lead to death if infiltration of vital organs is presented, above all in cases of abdominal or maxillo-facial mass localization. The authors present their experience with 17 cases of aggressive fibromatosis observed in our centre: four of abdominal localization, six in extremities, five in the maxillo-facial mass, one in the torax and one in the lumbo-sacral region. Histological diagnosis, either by puncture or biopsy, is complemented by studies of extension of the tumour based on ecography and TAC. All cases were treated according to the classical criteria of ample resection of the lesion, always when practicable, except in one infant case and in the torax, in which only a biopsy was effected. Of the 15 cases resected, nine cases had local relapses, six of which remained free of disease with a second operation, another two required a third operation and the remaining case needed five interventions. In six children chemotherapy was applied with vincristina, cyclophosphamide and adriamicina. A follow up was carried out in 14 patients, one of which died and the remaining 13 are free of disease. In spite of the fact that progestagene receptors were not evidenced in two of our cases, one presented complete remission of the tumor after treatment with medroxyprogesterone. In this case the coincidence of Gardner's syndrome arises in the family history.(ABSTRACT TRUNCATED AT 250 WORDS)

[Embryonal fatty tumors. Lipoblastoma-lipoblastomatosis]. / Tumores de grasa embrionaria. Lipoblastoma-lipoblastomatosis.

The authors present four cases. The first case is a diaphragmatic-mediastinal, the second one is a cervical-mediastinal one, the third case has a buttock, the last one is a case of hip-thigh. Their ages are one, eight and three years old and the fourth case is seven days old. They appear in axilla, neck, thoracic wall and fat prevertebral tissue, in below three year old children. Despite their benignity, the tumors grow very fast. The complete extirpation is fundamental to avoid relapses, which are presented approximately in a 15 for 100 of the cases. Mutilations are not necessary, since it is a benign tumor. Finally, the authors amply review the literature. They differentiate the concepts of lipoma, hibernoma and lipoblastoma.