[Chromophobe carcinoma of the kidney]. / Carcinoma cromófobo de riñón.

INTRODUCTION: Chromophobe renal cell carcinoma, described in 1985 is a type of renal carcinoma which is relatively uncommon (5%). Although the majority of studies published suggest a more favourable prognosis, conclusive evidence does not exist. In this study we present the clinical and ultrastructural characteristics and particularly the prognoses of 15 patients taken from a group of 230, all of whom had been diagnosed as suffering from renal carcinoma and for which they had received surgical treatment. MATERIAL AND METHODS: 230 kidneys were analysed between June 1990 and December 1997. The tissue was fixed and dyed with H-E, Hale's acid iron colloid and PAS. Two models were defined, typical and eosinophil. In 8 cases the tissue was processed in order to quantify the DNA using flow cytometry. RESULTS: Of the 230 kidneys analyzed, 15 were identified as being compatible with a diagnosis of chromophobe carcinoma, representing 6.5% of the group studied whilst 73% corresponded to the typical model. The average follow-up period for the 15 patients studied was of three and a half years. Upon completion of the study, 14 out of the 15 patients were still alive and the remaining one had died from causes unrelated to his illness. The average period of survival was 43 months. The tumors had an average diameter of 7.9 cm. The nuclear grade was GII on 10 occasions (seven T2, one T3a and two T3b) and GIII on 5 (four T2, one T3a and two T3b). The study of flow cytometry showed four cases of multiploids two of aneuploids one tetraploid and one diploid. CONCLUSIONS: Chromophobe renal cell carcinoma is a relatively uncommon (6.5%) type of renal carcinoma. The typical ultrastructural type is the most common (73%). The highly favourable pathologic stage (p2 73%) and the significantly low nuclear grade (66% GII) suggest that this is a tumour with a rather better prognosis, as is shown by an increased period of survival.

[Cystic pyeloureteritis]. / Pieloureteritis quística.

The pyelitis or cystic pyeloureteritis is a rare disease of unknown etiology. The clinic is unspecific and the treatment, medical and expectant. The importance of this disease consists of a correct differential diagnosis with other repletion defect imaging in the excretory tract and its frequent association to other diseases.

Effect of digital rectal examination and flexible cystoscopy on free and total prostate-specific antigen, and the percentage of free prostate-specific antigen. Differences between two PSA assays.

OBJECTIVE: To determine the effect of prostate manipulations on free PSA, total PSA and the percentage of free PSA using an equimolar and nonequimolar PSA assays. METHOD: A total of 67 men were studied. Blood samples were obtained before and 45-60 min after two different prostatic manipulations: DRE from 45 patients and flexible cystoscopy from 22 patients. Total PSA (t-PSA) was assayed with a non equimolar method using the Cobas Core PSA kit from Roche (Cobas Core-PSA) and an equimolar method using the Immulite 3rd-generation PSA kit from DPC (Immulite-PSA). Free PSA (f-PSA) was quantified with an Immulite free PSA kit. We obtained two f-PSA/t-PSA ratios dividing the f-PSA by both t-PSA (Cobas Core-PSA) and t-PSA (Immulite-PSA). RESULTS: The Cobas Core-PSA yielded higher values than Immulite-PSA and the baseline percentages of free PSA were different depending on the method used. Both t-PSA values were increased after DRE and flexible cystoscopy from the baseline although the increase of Cobas Core-PSA was much higher than Immulite-PSA. Also the f-PSA was increased after the two manipulations. The f-PSA/t-PSA ratio (Cobas Core-PSA) remains at the baseline whereas the f-PSA/t-PSA ratio (Immulite-PSA) had an important increase from the baseline. CONCLUSION: The effect of DRE and flexible cystoscopy is different depending on the PSA assay used. The data from studies which are carried out in relation with the molecular forms of the PSA are not interchangeable if they are performed with different PSA methods (equimolar and nonequimolar). The serum samples should precede any prostate manipulation in all investigations related to PSA molecular forms.

Surgical management of retroperitoneal tumors with vena caval thrombus in the inferior cava using cardiopulmonary bypass, arrested circulation and profound hypothermia.

OBJECTIVE: It was our aim to review our surgical experience with retroperitoneal tumors extending to the vena cava by using cardiopulmonary bypass, deep hypothermia and circulatory arrest. METHOD: We performed this procedure in 15 patients. The ages ranged between 16 and 70 years. The primary malignancies were renal cell carcinoma (n = 13), Wilms' tumor (n = 1) and paratesticular rhabdomyosarcoma (n = 1). RESULTS: There were no operative deaths. One patient died on the fourth postoperative day because of pulmonary embolization. The most common postoperative complications were: 1 patient required surgical reexploration because of hemorrhage, there was transitory renal failure in 3 patients, 1 patient developed a postoperative reactive psychosis and 1 patient developed a subclinical pericarditis. CONCLUSION: We believe that the resection of retroperitoneal malignancies with venous tumor thrombus extension offers, in selected patients, the only chance of reasonable long-term survival. The application of a cardiopulmonary bypass and hypothermia in high level vena cava thrombi is an important advance that has improved the safety and technical efficacy of a difficult surgical undertaking.

Incidentally detected renal cell carcinoma.

OBJECTIVES: To determine the incidence of renal cell carcinoma (RCC) detected incidentally and to compare the survival of these patients with that of patients presenting with suspected RCC. PATIENTS AND METHODS: In a retrospective study, 157 patients surgically treated for RCC from 1979 to 1993 were grouped according to whether the tumour was found incidentally (n = 55) or whether the renal tumour was suspected (n = 102). The groups were compared for tumour grade, stage and size, patient age, sex and survival using univariate and multivariate analyses. RESULTS: There were significant differences between the groups in the number of patients with T2 (P < 0.001), T3a (P < 0.05), T3b (P < 0.01), T4 (P < 0.05) and M1 (P < 0.05) stages of disease. There was also a significantly greater proportion of patients with grade 1-2 tumours (P < 0.05) in those diagnosed incidentally. The accumulated overall survival rate was 64% at 5 years, 50% in the group with suspected RCC and 86% in those with tumours discovered incidentally over the same period. There were significant differences (P < 0.001) in the distribution of survival in the two groups. CONCLUSION: The patients with incidentally discovered RCC had a prognostically more favourable tumour stage, grade and size. Pathological stage and lymph node metastases influenced the difference in survival between the groups. As there was no difference in survival with tumour stage (T1-2), we consider that grade, size and particularly pathological stage determine the better prognosis.

[Bilateral synchronous adrenal metastasis of renal adenocarcinoma]. / Metástasis suprarrenales bilaterales sincrónicas de adenocarcinoma renal.

Contribution of one case of renal adenocarcinoma with synchronous metastasis in both adrenal glands. Treatment was radical surgery with palliative resolution and steroid replacement therapy. Brief comments on this uncommon clinical situation and review of other author's experience.

[Urothelial inverted papilloma]. / Papiloma invertido urotelial.

Review of 60 cases of inverted urothelial papilloma published in our country in different urological journals. Analysis of clinical, diagnostic and therapeutical issues. Also an analysis is made of the possible association with other neoplasias or their malignant development.

[Idiopathic retroperitoneal fibrosis. Report of 12 cases]. / Fibrosis retroperitoneal idiopática. Presentación de 12 casos.

Review of 12 patients with diagnosis of idiopathic retroperitoneal fibrosis (IRF). To establish diagnosis, computerized axial tomography (CT) was used in all cases. Nine patients underwent surgical treatment. After a mean follow-up of three and a half years, the clinical and laboratory (serum creatinine) evolution appears to be favourable.

[TPS in prostate cancer]. / TPS en cáncer de próstata.

A study of the tumour proliferation marker TPS in prostate cancer has been carried out. The levels of this marker were determined in the following groups: controls (n = 51), prostate hyperplasia (n = 17), prostate cancer in clinical remission (n = 15), and progressive prostate cancer (n = 13). An upper normal limit of 129 U/l (percentile 95) was established. When the progressive disease group was compared with the other groups, a significant difference (p < 0.001) was found. Sensitivity, specificity and positive predictive value obtained in order to dismiss progression were 71%, 94% and 62% respectively.

[Errors in the clinical staging of prostatic cancer]. / Errores en el estadiaje clínico del cáncer de próstata.

The relationship between the clinical and pathological stages of clinically localized prostate cancer (PCa) was analyzed in 68 patients. All of then underwent ilio-obstructive lymphadenectomy and node affectation was found in 16 patients (23%). Out of 64 patients undergoing radical prostatectomy, 23 (36%) presented invasion of prostate capsule and/or seminal vesicle infiltration. Of the total 68 patients, 28 (41%) showed local dissemination and/or nodular affectation. A direct correlation was seen between clinical stage and both incidence of local dissemination and nodular affectation. Pre-operative PSA and tumoral grade were correlated to the pathological stage.

[Bladder leiomyoma: report of a new case]. / Leiomioma vesical: aportación de un nuevo caso.

We present one case of vesical intramural leiomyoma in one adult woman in which an echographic fortuitous diagnostic was made. We have reviewed the bibliography and the diagnostic and therapy considerations.