[Prognostic significance of the microscopic invasion of the renal vein wall in renal cell cancer]. / Valor pronóstico de la afectación microscópica de la vena renal en el cáncer de células renales.

OBJECTIVES: International TNM Staging System for renal cell carcinoma (RCC) classifies as T3b when "tumor grossly extends into the renal vein or its segmental branches, or vena cava below the diaphragm". The finding of microscopic invasion of the vein wall is not taken into account for TNM staging. We analyse its prognostic significance in localized and locally advanced RCC. METHODS: From January 1989 to July 2002, 257 RCC were surgically excised. Excluding Von Hippel-Lindau patients and stage IV (TNM 2002), 241 cases were studied in retrospect, with a median follow up of 50.96 months. Histopathological data from the renal vein were available in 216 specimens. There was renal vein wall invasion in 22. We compare the outcomes in this group vs. the group without microscopic involvement of the renal vein wall (n: 194). RESULTS: Mean age for the group with renal vein invasion (RVI) was 65.02 years. Mean tumour size in the same group was 9 cm, larger than in control group (p<0,001). Thrombus was found in 72.7% vs. 6.2% in the control group. Clear cell carcinoma (77.3%) was the predominant histological subtype. Nuclear grade 2 according to Fuhrman's Classification System accounts for 42.9% of the cases. Metastatic progression risk (HR: 4,86) and death risk (HR: 6,49) are significantly higher in RVI group. When renal vein thrombosis is found, progression and death risks are still higher (HR: 7.22 and 8.38, respectively). CONCLUSIONS: Microscopic invasion of the renal vein wall is a dependent prognostic factor for disease progression and death for RCC. Macroscopic renal vein involvement is an independent prognostic factor. When both factors are found together, disease outcome is worse.

Valor pronostico de la afectación microscópica de la vena renal en el cáncer de células renales / Prognostic significance of the microscopic invasion of the renal vein wall in renal cell cancer

OBJETIVO: En el carcinoma de células renales, la TNM define el estadio T3b como afectación macroscópica de la vena renal o cava infradiafragmática. El valor pronóstico de la invasión microscópica de la pared de la vena no se contempla. Analizamos la repercusión de ésta en la evolución de estos tumores, en estadios localizados y localmente avanzados.MÉTODOS: De 257 carcinomas de células renales operados (Enero de 1989 / Julio de 2002), se analizan retrospectivamente 241 (excluímos los estadios IV y los casos con enfermedad de Von-Hippel-Lindau). El seguimiento mediano es de 50,96 meses. Tenemos datos de la histología de la vena en 216 casos. Comparamos el grupo con invasión microscópica de la pared (22 casos) frente al resto (n: 194).RESULTADO: En el grupo con afectación de la pared, la edad media es 65,02 años. El tamaño medio es 9 cm (significativamente superior, p< 0,001). El 72,7% presentan trombo frente al 6,2% del segundo grupo. El 77,3% corresponden a tumores de células claras. El 42,9% tienen un grado 2 de Fuhrman. El riesgo de desarrollar metástasis (HR: 4,86) y de éxitus (HR: 6,49) es significativamente superior en el grupo con afectación de la pared. Este riesgo es superior ante la presencia de trombo (HR: 7,22 y HR: 8,38, respectivamente).CONCLUSIONES: La afectación microscópica de la pared de la vena renal actúa como factor pronóstico dependiente para la supervivencia y para la progresión. La afectación macroscópica de la vena actúa como factor pronóstico independiente, aunque los pacientes que presentan ambas circunstancias (afectación macro y microscópica) son los que presentan peor evolución(AU)

OBJECTIVES: International TNM Staging System for renal cell carcinoma (RCC) classifies as T3b when “tumor grossly extends into the renal vein or its segmental branches, or vena cava below the diaphragm”. The finding of microscopic invasion of the vein wall is not taken into account for TNM staging. We analyse its prognostic significance in localized and locally advanced RCC. METHODS: From January 1989 to July 2002, 257 RCC were surgically excised. Excluding Von Hippel-Lindau patients and stage IV (TNM 2002), 241 cases were studied in retrospect, with a median follow up of 50.96 months. Histopathological data from the renal vein were available in 216 specimens. There was renal vein wall invasion in 22. We compare the outcomes in this group vs. the group without microscopic involvement of the renal vein wall (n: 194).RESULTS: Mean age for the group with renal vein invasion (RVI) was 65.02 years. Mean tumour size in the same group was 9 cm, larger than in control group (p<0,001). Thrombus was found in 72.7% vs. 6.2% in the control group. Clear cell carcinoma (77.3%) was the predominant histological subtype. Nuclear grade 2 according to Fuhrman’s Classification System accounts for 42.9% of the cases. Metastatic progression risk (HR: 4,86) and death risk (HR: 6,49) are significantly higher in RVI group. When renal vein thrombosis is found, progression and death risks are still higher (HR: 7.22 and 8.38, respectively).CONCLUSIONS: Microscopic invasion of the renal vein wall is a dependent prognostic factor for disease progression and death for RCC. Macroscopic renal vein involvement is an independent prognostic factor. When both factors are found together, disease outcome is worse(AU)

[Atypical lymphatic dissemination of a testicular tumor from a cryptorquid testicle]. / Diseminación linfática atípica de un tumor testicular sobre un testículo criptorquídico.

OBJECTIVES: Atypical lymphatic spread of germ cell tumors to inguinal lymph nodes has been reported mostly related to prior surgical involvement of the inguinoscrotal region, as in orchiopexy. METHODS: A patient with cryptorchidism and failed orchiopexy in his childhood was diagnosed with a testicular neoplasm. Inguinal orchiectomy was performed. RESULTS: Pathological analysis showed classical seminoma spreading into a subcutaneous adjacent lymph node. Further metastatic disease was not found. Patient was treated with adjuvant chemotherapy. CONCLUSIONS: We emphasize the need for accurate staging and a multidisciplinary approach when dealing with onco-urological patients presenting with atypical disease.

Diseminación linfática atípica de un tumor testicular sobre testículo criptorquídico / Atypical lymphatic dissemination of a testicular tumor from a chriptorquid testicle

OBJETIVOS: Existen casos descritos en la literatura de diseminación linfática atípica de un tumor testicular a ganglios inguinales, en la mayoría de las ocasiones asociados a una cirugía previa de la región inguinal o testicular, como es el caso de la orquidopexia en testículos criptorquídicos. MÉTODOS: Presentamos el caso clínico de un paciente con testículo criptorquídico con orquidopexia previa fallida, en el que se diagnostica un tumor testicular y se realiza orquiectomía.RESULTADOS: En el análisis histopatológico se objetiva un tumor de estirpe seminomatosa sobre testículo criptorquídico, así como una diseminación a estación linfática inguinal ipsilateral. El paciente es tratado con quimioterapia complementaria.CONCLUSIONES: Se pretende mostrar la necesidad de establecer una correcta estadificación y el tratamiento más adecuado en los casos con este tipo de afectación linfática(AU)

OBJECTIVES: Atypical lymphatic spread of germ cell tumors to inguinal lymph nodes has been reported mostly related to prior surgical involvement of the inguinos-crotal region, as in orchiopexy.METHODS: A patient with cryptorchidism and failed orchio-pexy in his childhood was diagnosed with a testicular neo-plasm. Inguinal orchiectomy was performed.RESULTS: Pathological analysis showed classical seminoma spreading into a subcutaneous adjacent lymph node. Further metastatic disease was not found. Patient was treated with adjuvant chemotherapy.CONCLUSIONS: We emphasize the need for accurate sta-ging and a multidisciplinary approach when dealing with onco-urological patients presenting with atypical disease(AU)

[Adenomatoid tumor of the epididymis. Report of two cases]. / Tumor adenomatoide de epidídimo. Aportación de dos casos.

OBJECTIVE: Tumors of the epididymis are rare. They are unusually benign and adenomatoid tumors are the most frequent. Report of two cases of this kind of tumor of the epididymis. METHODS/RESULTS: We report two cases of adenomatoid tumor of the epididymis diagnosed at our hospital during last year. Two males, 35 and 54 years old respectively asked for urology consultation about a palpable scrotal mass. They didn't have any other symptoms. Imaging techniques revealed a solid epididymal mass. Epididymectomy was performed. Pathological diagnosis was adenomatoid tumor. CONCLUSIONS: The majority of epididymal tumors follow a benign course. In the finding of an epididymal mass, after palpation and imaging tests, organ sparing surgery (epididymectomy) is recommended. We will avoid unnecessary orchiectomies.

Tumor adenomatoide de epidídimo. Aportación de dos casos / Adenomatoid tumor of the epididymis. Report of two cases

Objetivo: Los tumores de epidídimo constituyen una entidad de rara aparición. Son en su mayoría benignos y de entre estos los más frecuentes son los tumores adenomatoides. Presentamos dos casos de este tipo de tumor epididimario. Método/Resultados: Presentamos dos casos de tumor adenomatoide de epidídimo diagnosticados en nuestro hospital en el último año. Se trata de dos varones de 35 y 54 años, que acudieron a la consulta de urología por autopalpación de masa intraescrotal, en los que se diagnostica este tipo de tumor tras la realización de epidimectomía, en el estudio histopatológico. Conclusiones: La mayoría de los tumores de epidídimo presentan una evolución benigna. Ante el hallazgo de masa epididimaria tras exploración física y pruebas de imagen es recomendable la realización de cirugía conservadora testicular, mediante epididimectomía. Evitaremos de este modo orquiectomías innecesarias (AU)

Objective: Tumors of the epididymis are rare. They are ususally benign and adenomatoid tumors are the most frequent. Report of two cases of this kind of tumor of the epididymis. Methods/Results: We report two cases of adenomatoid tumor of the epididymis diagnosed at our hospital during last year. Two males, 35 and 54 years old respectively asked for urology consultation about a palpable scrotal mass. They didn't have any other symptoms. Imaging techniques revealed a solid epididymal mass. Epidydimectomy was performed. Pathological diagnosis was adenomatoid tumor. Conclusions: The majority of epipidydimal tumors follow a benign course. In the finding of an epididymal mass, after palpation and imaging tests, organ sparing surgery (epididymectomy) is recommended. We will avoid unnecessary orchiectomies (AU)

[Bladder leiomyoma in a male patient]. / Leiomioma vesical en un varón.

OBJECTIVES: Bladder leiomyoma is an uncommon mesenchymal benign tumor. It is generally asymptomatic and incidentally detected. METHODS: We report a new case managed with transurethral resection without evidence of relapse. A bibliographic search was performed to evaluate the diagnostic techniques, clinical features and treatment options of this rare disease. CONCLUSIONS: Bladder leiomyoma is a benign mesenchymal tumor originating from smooth muscle. Biopsy and histological study are required for definitive diagnosis. Surgery is the treatment of choice, and it has an excellent prognosis if resection is complete.

Fractura de pene / Penile rupture

OBJETIVOS: La fractura de los cuerpos cavernosos es una patología infrecuente que requiere tratamiento urgente. Se analizan los distintos métodos diagnósticos y terapéuticos, realizando una revisión de la literatura. MÉTODOS/RESULTADOS: Se presentan dos casos de rotura traumática de cuerpos cavernosos, describiendo su sintomatología, la utilidad de la ecografía como prueba diagnóstica y el buen resultado del tratamiento quirúrgico urgente. CONCLUSIONES: La fractura de pene es una patología infrecuente. Para su diagnóstico suele ser suficiente con la anamnesis y la exploración. En caso de duda la ecografía es la prueba complementaria de mayor rendimiento. El mejor tratamiento, para la mayoría de los urólogos, es la cirugía urgente (AU)

[Penile fracture]. / Fractura de pene.

OBJECTIVES: Rupture of the corpora cavernosum is an uncommon pathology requiring immediate treatment. We performed a bibliographic search, and analyzed different diagnostic and therapeutic methods. METHODS/RESULTS: Two cases of traumatic rupture of the corpus cavernosum are described. The clinical features, penile ultrasound findings and immediate surgical treatment are discussed. CONCLUSIONS: Penile fracture is an uncommon pathology. Generally, history and physical examination are enough to establish the diagnosis. Penile ultrasound can help in case of doubt. Most urologists deem immediate surgery the standard therapy.