Early Macrophage Infiltration and Sustained Inflammation in Kidneys From Deceased Donors Are Associated With Long-Term Renal Function.

Kidney transplants from living donors (LDs) have a better outcome than those from deceased donors (DDs). Different factors have been suggested to justify the different outcome. In this study, we analyzed the infiltration and phenotype of monocytes/macrophages and the expression of inflammatory and fibrotic markers in renal biopsy specimens from 94 kidney recipients (60 DDs and 34 LDs) at baseline and 4 months after transplantation. We evaluated their association with medium- and long-term renal function. At baseline, inflammatory gene expression was higher in DDs than in LDs. These results were confirmed by the high number of CD68-positive cells in DD kidneys, which correlated negatively with long-term renal function. Expression of the fibrotic markers vimentin, fibronectin, and α-smooth muscle actin was more elevated in biopsy specimens from DDs at 4 months than in those from LDs. Gene expression of inflammatory and fibrotic markers at 4 months and difference between 4 months and baseline correlated negatively with medium- and long-term renal function in DDs. Multivariate analysis point to transforming growth factor-ß1 as the best predictor of long-term renal function in DDs. We conclude that early macrophage infiltration, sustained inflammation, and transforming growth factor-ß1 expression, at least for the first 4 months, contribute significantly to the difference in DD and LD transplant outcome.

Extensión vesical de un adenocarcinoma de próstata / Bladder extensión of a protate adenocarcinoma

El adenocarcinoma de próstata de localización vesical es un tumor infrecuente que supone un reto diagnóstico debido a la escasa bibliografía que se encuentra publicada al respecto. La finalidad de este artículo es exponer las bases histológicas y los nuevos marcadores que se usan actualmente para el diagnóstico anatomopatológico de las estirpes de adenocarcinoma vesical, así como la prueba de elección para su biopsia según la evidencia clínica. Para ello se presenta el caso clínico de un paciente remitido a nuestro centro para ser estudiado por hematuria monosintomática (AU)

Prostate adenocarcinoma located in the bladder is an uncommon tumor that presents a diagnostic challenge because of the limited literature published in this regard. The aim of this article is to outline the basis of histological criteria and new markers that are currently used for histopathological diagnosis of strains of bladder adenocarcinoma, and the gold standard for biopsy according to clinical evidence. To that purpose we report a case of a patient referred to our center to be examined for a monosymptomatic hematuria (AU)

Anomalías congénitas del testículo / Congenital abnormalities of the testicle

Se presentan las principales anomalías congénitas del testículo, desde las alteraciones por topografía, tamaño y alteraciones anatómicas hasta las secundarias a procesos genéticas

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Gestión de riesgos en la prevención de errores de medicación / Management of risk in the prevention of medical mistakes

Se define como error de medicación (EM) a cualquier incidente prevenible que pueda causar daño al paciente o dé lugar a una utilización inapropiada de los medicamentos, mientras la medicación está bajo control de personal sanitario, paciente o consumidor. Los EM son responsables del 5,3% de los ingresos hospitalarios en Barcelona y pueden representar un 4,7% de los costos en servicios médicos. Los más frecuentes eventos adversos intrahospitalarios en los hospitales españoles son aquellos asociados con medicación (37,4%). Estos acontecimientos adversos prevenibles ameritan de la creación de un sistema de seguridad que pueda reducir al máximo los errores en sus procesos o garantizar que, si éstos ocurren, no alcancen a los pacientes. La clave para la reducción de los EM en los hospitales radica en establecer una sistemática continua de evaluación y mejora de los procesos que integran los sistemas de utilización de medicamentos y en la detección y análisis de los EM que se producen. Se han propuesto una serie de recomendaciones o medidas para la prevención de los EM en las instituciones sanitarias (AU)

Medication error (ME) is defined as any preventible incident that could barm the patient or give place to misuse of medication while under control of sanitary personel, patient or consumer. Up to 5,3% of hospitalary admissions in Barcelona are related to ME and represents a 4,7% of total costs of medical services. The most frequent intrahospitalary adverse events in Spain are those associated with medication (37,4%). These preventable adverse events deserve the creation of a security system able to reduce the errors in its processes. The key to error reduction is to establish a continuous systematic evaluation an improvement of the proceses involved in medication banding. It has been proposed several mesasures to prevent ME in sanitary institutions (AU)

Cáncer insignificante de próstata: ¿existe realmente? Criterios diagnósticos en la pieza de prostatectomía radical / Insignificant prostate cancer. Does it really exist? Diagnostic criteria of the radial postatectomy specimen

El incremento del uso del PSA para la detección precoz del cáncer de próstata ha comportado el hallazgo en biopsias de adenocarcinomas que, al hacer las prostatectomías, demuestran ser muy pequeños y con signos de baja agresividad, por lo que se ha empezado a pensar en la posibilidad de que algunos de estos carcinomas quizás no serían de importancia vital para el paciente, es decir que serían clínicamente insignificantes. Este artículo presenta algunos de los aspectos que se están considerando en el intento de reconocer qué carcinomas son insignificantes y cuales no (AU)

Increasing use of PSA for prostate cancer early detection has brought about the discovery of adenocarcinomas in the biopsies that, when performing prostatectomy, prove very small and show low signs of aggressiveness; consequently, the concept has arisen that it sis possible that perhaps some of these carcinomas are not critically important for the patient, i.e, they are not clinically significant. This article discusses some of the aspects now being considered when attempting to know which carcinomas are significant and which are not (AU)

Desarrollo y evolución del testículo / Development and evolution of the testicle

El tracto genital es idéntico en ambos sexos hasta la séptima semana del desarrollo embriológico. El desarrollo de las células germinales es posible por la acción del gen SRY que actuando a través de las células de Sertoli, induce el paro de las mitosis en las células germinales primordiales, éstas de Sertoli, induce el paro de las mitosis en las células germinales primordiales, éstas migran a la cresta gonadal, se transforman en preespermatogonias y actúan sobre las células precursoras de las células de Leydig. Durante el primer trimestre la mayoría de las células son de fenotipo gonocito; sin embargo desde la semana 18 de gestación las preespermatogonias serán el tipo celular más frecuente. A partir de los 9 años y sobre todo entre los 13 y 15 años, bajo la acción de la hormona luteínica, las células mesenquimales intersticiales se transforman definitivamente en células de Leydig adultas, cuya testosterona, junto a la horona luteinizante, producen el desarrollo de las células germinales, crecimiento del túbulo y aparición de luz central. El testículo puberal (adulto) se caracteriza por la amplia expresión de todas las series germinales celulares. Los cambios considerados como involutivos no tienen una edad específica de inicio y hay marcadas variaciones individuales, pudiéndose ver en todos los grupos etarios testículos normales. La involución parece estar más relacionada con los niveles hormonales que con la edad por si misma (AU)

The embryonal development of the genital tract is identical in both sexes until the seventh week of gestation. The development of the germ cells is made possible by the SRY gene, which in acting through the Sertoli cells, stops mitosis in the primordial germ cells; these primordial cells migrate to the gonadal crest, are transformed into prespermatogonia, and act on the Leydig cells precursors. In the first trimester; most germ cells have a gonocyte phenotype; however, from the 18 th week of gestation, prespermatogonia are the most abundant cell type. From age 9 years and especially between ages 13 and 15 years, under the action of luteinic hormone, the interstitial mesenchymal cells are definitively transformed into adult Leydig cells that produce testosterone; in addition, luteinizing hormone stimulates the development of the germinal epithelium, growth of the tubule, and appearance of the central lumen. The changes considered as age-related involution do not have a specific age at commencement, and the fact that we are able to see normal testicles in all age groups indicates that there are marked individual variations. The involution seems to be related more to hormonal levels than to age (AU)

Estructura morfobiológica del acino prostático / Morphological structure of the prostactic acini

El conocimiento de la estructura normal del acino prostático es el primer paso para poder intentar entender el proceso de transformación maligna. Esta es la finalidad de esta breve reseña, que es la primera de una serie que pretende ir exponiendo aspectos morfobiológicos del cáncer de próstata (AU)

Being aware of the prostatic acinues normal structure is the first step towards understanding the malignant transformation process. Such is the aim of this brief review, the first one of a series whose objective is to display the morphobiological aspects of prostatic cancer (AU)

Lesiones histopatológicas elementales en nefrología / Element histopahological lesion in nephrology

Presentamos un resumen sobre cómo nos aproximamos a la patología renal desde la anatomía patológica mostrando cómo manipulamos las biopsias renales desde su procesamiento técnico hasta la valoración de las lesiones histopatológicas básicas, que junto con la valoración clínica, nos permitirán alcanzar el diagnóstico de cada caso

We present a summary of a how we approach to the renal pathology from the pathological anatomy showing how we manipule the renal biopsies, from its technical processing until the evaluation of basic histological lesions, which together with the clinical assessment will enable us to achieve the diagnosis of each case

La biopsia intraoperatoria en patología oncológica urológica / Frozen section in urological oncology

Las indicaciones de la biopsia intraoperatoria (BI) en las cirugías por neoplasias urológicas son muy concretas, esto explica que sólo representen un 7´3% de las BI en los hospitales generales y motiva que se conozca de una forma precisa su utilidad, siendo éste el motivo la revisión que presentamos. En términos generales no está justificada la BI para identificar la naturaleza de una masa tumoral, a excepción de: 1) Las masas renales con dudas sobre el origen parenquimatoso o en vías urinarias. 2) En las neoplasias testiculares cuando se plantea la posibilidad de un tratamiento conservador. 3) La determinación de la presencia de un adenocarcinoma de próstata en un donante de órganos con PSA sérico elevado, pero incluso en estas circunstancias hay amplia discusión sobre su necesidad. La determinación intraoperatoria de los márgenes quirúrgicos es especialmente útil en: 1) Las nefrectomías parciales (puede limitarse a la inspección habiendo pintado con tinta china el margen y sólo muy ocasionalmente se precisa congelación del lecho). 2) El uretral en mujeres con cistectomías totales y sustitución ortotópica. 3) En las penectomías parciales (estudiando siempre el margen uretral y el de los cuerpos cavernosos y esponjoso). El estudio de los ganglios es un tema ampliamente debatido y salvo en casos del hallazgo de un inesperado aumento del tamaño ganglionar no está indicada la BI sistemática ni en vejiga ni en próstata. Otra es la situación en el carcinoma de pene ya que en los grupos de riesgo intermedio y alto de metástasis ganglionar, aunque haya de un 16% a un 18% de falsos negativos se recomienda BI, especialmente de los ganglios centinelas marcados con radioisótopos

The indications of Frozen section diagnosis (FS) in surgery due to urologic neoplasia are quite specific, and this explains the fact that they amount to a mere 7.3% of the FSs performed in general hospitals. This also makes the precise knowledge of their usefulness necessary, and thus we are submitting the present review. Generally speaking, FS is not warranted to identify the nature of a tumoral mass, with the following exceptions: 1) Renal masses of a doubtful parenchymal origin, or in the urinary tract: 2) In testicular neoplasias, when the possibility of a conservative treatment arises; 3) Determination of the presence of a prostate adenocarcinoma in an organ donor with high serum PSA; but even in these circumstances its need is widely controversial. Intraoperative determination of surgical margins is particularly useful in: 1) Partial nephrectomies (it may be limited to inspection after dyeing the margin with Indian ink - bed freezing is very seldom needed); 2) Urethral margins in women with total cystectomies and orthotopic substitution; 3) In partial penectomies (always studying the urethral margin and the cavernosal and spongiosal corpora margins). The study of the nodes is a widely debated issue, and except for those cases in which unexpectedly increased node size is found, systematic FS is indicated neither of the bladder nor of the prostate. The situation regarding penis carcinoma is different, as in the groups with intermediate and high risk of node metastasis, even though there is around 16% - 18% of false negatives FS is recommended, particularly of radioisotope-marked sentinel nodes

Pseudoneoplastic lesions of the testis and paratesticular structures.

Pseudotumors or tumor-like proliferations (non-neoplastic masses) and benign mimickers (non-neoplastic cellular proliferations) are rare in the testis and paratesticular structures. Clinically, these lesions (cysts, ectopic tissues, and vascular, inflammatory, or hyperplastic lesions) are of great interest for the reason that, because of the topography, they may be relevant as differential diagnoses. The purpose of this paper is to present an overview of the pseudoneoplasic entities arising in the testis and paratesticular structures; emphasis is placed on how the practicing pathologist may distinguish benign mimickers and pseudotumors from true neoplasia. These lesions can be classified as macroscopic or microscopic mimickers of neoplasia.

Mieloma múltiple y fracaso renal agudo / Multiple mieloma and acute renal failure

El mieloma múltiple es una proliferación neoplásica de células plasmáticas que producen una inmunoglobulina de forma monoclonal. Representa el 1% de todas las enfermedades malignas y el 10% de las enfermedades malignas hematológicas siendo más frecuente en hombres con una edad media al diagnóstico de 66 años. La afectación renal en el mieloma múltiple es frecuente y en el momento de presentación, la alteración de la función renal puede ser presente en el 50% de los casos. Se presenta el caso de uan paciente de 71 años que fue diagnosticada de mieloma múltiple a raíz de un fracaso renal agudo. Se realizó una biopsia renal objetivándose imágenes compatibles con nefropatía por mieloma. Tras llegar al diagnóstico de mieloma múltiple a través de biopsia de médula ósea se realizó tratamiento quimioterápico con vincristina, adriamicina y dexametasona sin presentar respuesta de su enfermedad de base

The múltiple myeloma is a neoplasis proliferation of plasma cells that produce an immunoglobulin of monoclonal form. It represents the 1% of all the malignant diseases and 10% of the haematological malignant diseases, being more frequent in men with a middle ages to the diagnosis of 66 years. The renal affectation in the multiple myeloma is frequent and in the moment of presentation, the renal function alteration can be present in the 50% of cases. The case appears of patient of 71 years who was diagnosed of multiple myeloma immediately after a renal sharp failure. It was realized a renal biopsy with the vision of images compatible with nephropathy by myeloma. After coming to the diagnosis of multiple myeloma through bone marrow´s biopsy, it was made a chemotherapeutic treatment with vincristina, adriamicina and dexametasona without to show response of his base disease

[Frozen section in urological oncology]. / La biopsia intraoperatoria en patología oncológica urológica.

The indications of Frozen section diagnosis (FS) in surgery due to urologic neoplasia are quite specific, and this explains the fact that they amount to a mere 7.3% of the FSs performed in general hospitals. This also makes the knowledge of their usefulness necessary, and thus we are submitting the present review. Generally speaking, FS is not warranted to identify the nature of a tumoral mass, with the following exceptions: (1) Renal masses of a doubtf ul parenchymal origin, or in the urinary tract: (2) Intesticular neoplasias,when the possibility of a conservative treatment arises; (3) Determination of the presence of a prostate adenocarcinoma in an organ donor with high serum PSA; but even in these circumstances its need is widely controversial. Intraoperative determination of surgical margins is particularly useful in: (1) Partial nephrectomies (it may be limited to inspection after dyeing the margin with Indian ink--bed freezing is very seldom needed); (2) Urethral margins in women with total cystectomies and orthotopic substitution; (3) In partial penectomies (always studying the urethral margin and the cavernosal and spongIosal corpora margins). The study of the nodes is a widely debated issue, and except for those cases in which unexpectedly increased node size is found, systematic FS is indicated neither of the bladder nor of the prostate. The situation regarding penis carcinoma is different, as in the groups with intermediate and high risk of node metastasis, even though there is around 16%-18% of false negatives FS is recommended, particularly of radioisotope-marked sentinel nodes.

La neoplasia prostática intraepitelial de alto grado. La perspectiva del patólogo / High degree prostatic intraepithelial cancer. The point of view of the pathologist

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[Usefulness of the present renal cell carcinoma classifications]. / Aplicación clínica de las actuales clasificaciones del cáncer renal.

The purpose of classifying neoplasias is to recognize groups with similar progress and prognosis and, if possible, receiving the same treatment. This is why those classifications are systematically being submitted to review and improvement through the new technologies. Differentiation of various entities in renal cancer has been comparatively fast, as the new genetic and molecular discoveries have confirmed the morphologic criteria of the different cell types, thus making it possible to open new therapeutic pathways. Using the current WHO classification we recognize subtypes with excellent prognosis (Multilocular cystic renal carcinoma, Type I renal papillary carcinoma, Tubular and fusocellular mucinous carcinoma), other very aggressive ones (Bellini's collecting duct carcinoma, Medullary carcinoma), and also that the sarcomatoid transformation, even in small areas, impacts the prognosis negatively. Childhood-characteristic renal carcinomas associated with chromosome translocations have been recognized (genetic fusion TFE3 or TFEB), as well as the family forms of renal carcinoma. Regarding the UICC (International Union Against Cancer) classification, there are a series of aspects under argument (size, venous invasion, microvascular invasion, invasion of the adipous tissue of the renal sinus) that shall be discussed too, since it is possible that some modifications of the TNM might occur in the near future.

¿Cuál es el número óptimo de cilindros en la biopsia de próstata? La perspectiva del patólogo / What is the optimal number of cilinder in a prostatic biopsy. The point of view of the pathologist

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Tumor testicular bilateral en paciente con antecedentes de criptorquidia: a propósito de un caso / Bilateral testicular tumor in a patient with previous criptorquidia: a clinical case

La criptorquidia constituye un factor de riesgo para el desarrollo de un tumor testiculat: La bilateralidad sincrónica es un hecho infrecuente en los tumores testiculares. El seminoma con células sincitiotrofoblásticas es una variante de seminoma sin implicaciones pronósticas

Cryptorcbidism is a riskfactor to develop a testicular tumour. Synchronus bilateral testicular tumours are unusuaL Seminoma with syncytiotrophoblastic cells is one variant of seminoma without prognostic implications

La categoría pT0 del cáncer de próstata. La perspectiva del patólogo / The p10 category in the prostate cancer: the point of view of a pathologist

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Prognostic parameters other than Gleason score for the daily evaluation of prostate cancer in needle biopsy.

OBJECTIVE: To evaluate in prostate needle biopsies the usefulness and the efficacy of not time-consuming morphologic parameters in order to predict whether prostate cancer is organ-confined or it is not, that could contribute additional information to pre-surgical serum PSA and Gleason score, both of them parameters already accepted as clinically significant. METHODS: Three hundred and two consecutive patients were evaluated, of whom a diagnostic needle biopsy and the radical prostatectomy specimen with no pre-surgical hormone therapy were available. Bilateral or unilateral extension, number of positive cores, percentage of positive cores, intraprostatic perineural invasion (IPNI) and the presence of high-grade prostatic intraepithelial neoplasia (HGPIN) in any of the biopsy cores were evaluated in the needle biopsy. RESULTS: The median of cores is 6. The IPNI, the presence of bilateral tumour, and the percentage of positive cores, higher than 37.5% (ROC curve), show significant crude OR (4.0, 2.8, 6.9 respectively). The regression model discloses that only the percentage of positive cores shows a significant OR (5.8) adjusting for bilaterality, IPNI, HGPIN and age. CONCLUSIONS: The percentage of cores with cancer and the bilateral involvement are another two parameters predictive of cancer with extraprostatic extension. (p<0.0005 in both). IPNI has statistical significance too (p<0.002), but it is related to the tumour volume expressed through the two mentioned parameters.