Leiomiomas vesicales / Bladder leiomyomas

Los leiomiomas vesicales son tumores benignos infrecuentes, causan sintomatología miccional y su tratamiento es quirúrgico. Objetivo: Presentar nuestra experiencia en el diagnóstico y tratamiento del leiomioma vesical. Material y metodo: Serie de 3 casos clínicos. Resultados: De los 3 casos, 2 fueron mujeres y 1 fue hombre. La edad media fue 33 años. Las dos mujeres presentaron síntomas miccionales irritativos y palpación de una masa pélvica, y el hombre cursó asintomático. La ecografía halló una masa anexial e hidronefrosis izquierdas en una paciente, tumoración vesical en otra paciente y masa pélvica de etiología no definida en el paciente varón. La tomografía y la resonancia magnética demostraron el origen vesical de la lesión. La biopsia confirmó el diagnóstico de leiomioma. Se realizó cistectomía parcial en todos los casos, con nefrectomía en uno de ellos. Durante el seguimiento no ocurrió recidiva tumoral. Conclusiones: Los estudios de imagen nos orientan al diagnóstico. La resección transuretral está indicada en lesiones menores de 3 cm. y la enucleación o cistectomía parcial en lesiones de mayor tamaño. Su pronóstico es bueno

Bladder leiomyomas are rare benign tumors; their common presentation are irritative and obstructive urinary symptoms. The treatment is complete surgical resection. Objective: To present our experience in the diagnosis and the treatment of bladder leiomyoma. Methods: A series of three clinical cases. Results: In our series, two patients were women and one was man. The mean age was 33 years. Two women presented with irritative urinary symptoms and palpation of a pelvic mass, and the man was asymptomatic. Ultrasound showed the presence of an adnexal mass with left hydronephrosis in a female patient, bladder tumor in another female patient and pelvic mass of unknown etiology in the male patient. CT scan and MRI demonstrated the bladder origin of the lesion. A biopsy confirmed a bladder leiomyoma. Surgical treatment was partial cystectomy in all patients, and in one of them, nephrectomy was performed. During follow-up, all patients were asymptomatic and without recurrence. Conclusions: Imaging studies guide to diagnosis. Transurethral resection is recommended in lesions smaller than 3 cm. and enucleation or partial cystectomy in larger lesions. Prognosis is good

[Bladder leiomyomas.] / Leiomiomas vesicales.

Bladder leiomyomas are rare benign tumors; their common presentation are irritative and obstructive urinary symptoms. The treatment is complete surgical resection. OBJECTIVE: To present our experience in the diagnosis and the treatment of bladder leiomyoma. METHODS: A series of three clinical cases. RESULTS: In our series, two patients were women and one was man. The mean age was 33 years. Two women presented with irritative urinary symptoms and palpation of a pelvic mass, and the man was asymptomatic. Ultrasound showed the presence of an adnexal mass with left hydronephrosis in a female patient, bladder tumor in another female patient and pelvic mass of unknown etiology in the male patient. CT scan and MRI demonstrated the bladder origin of the lesion. A biopsy confirmed a bladder leiomyoma. Surgical treatment was partial cystectomy in all patients, and in one of them, nephrectomy was performed. During follow-up, all patients were asymptomatic and without recurrence. CONCLUSIONS: Imaging studies guide to diagnosis. Transurethral resection is recommended in lesions smaller than 3 cm. and enucleation or partial cystectomy in larger lesions. Prognosis is good.

Los leiomiomas vesicales son tumores benignos infrecuentes, causan sintomatología miccional y su tratamiento es quirúrgico. OBJETIVO: Presentar nuestra experiencia en el diagnóstico y tratamiento del leiomioma vesical. MATERIAL Y METODO: Serie de 3 casos clínicos. RESULTADOS: De los 3 casos, 2 fueron mujeres y 1 fue hombre. La edad media fue 33 años. Las dos mujeres presentaron síntomas miccionales irritativos y palpación de una masa pélvica, y el hombre cursó asintomático. La ecografía halló una masa anexial e hidronefrosis izquierdas en una paciente, tumoración vesical en otra paciente y masa pélvica de etiología no definida en el paciente varón. La tomografía y la resonancia magnética demostraron el origen vesical de la lesión. La biopsia confirmó el diagnóstico de leiomioma. Se realizó cistectomía parcial en todos los casos, con nefrectomía en uno de ellos. Durante el seguimiento no ocurrió recidiva tumoral. CONCLUSIONES: Los estudios de imagen nos orientan al diagnóstico. La resección transuretral está indicada en lesiones menores de 3 cm. y la enucleación o cistectomía parcial en lesiones de mayor tamaño. Su pronóstico es bueno.

Testicular adrenal rest tumors.

We report a case of congenital adrenal hyperplasia in a 29 year old patient, who presented with testicular pain, bilateral testicular masses, and oligospermia. Ultrasonography confirmed, in both testis, the presence of heterogeneous and hypoechoic lesions with irregular borders and internal and peripheral vascularization. Seric tumor markers were negative. The patient was scheduled for perioperative testicular biopsy and bilateral orchiectomy. Perioperative biopsy was suggestive of testicular adrenal rest tumor and not additional procedure was performed. Treatment was initiated with high doses of glucocorticoids, decreasing the size of testicular masses and testicular pain was alleviated.

Testicular adrenal rest tumors / Tumores testiculares de restos adrenales

We report a case of congenital adrenal hyperplasia in a 29 year old patient, who presented with testicular pain, bilateral testicular masses, and oligospermia. Ultrasonography confirmed, in both testis, the presence of heterogeneous and hypoechoic lesions with irregular borders and internal and peripheral vascularization. Seric tumor markers were negative. The patient was scheduled for perioperative testicular biopsy and bilateral orchiectomy. Perioperative biopsy was suggestive of testicular adrenal rest tumor and not additional procedure was performed. Treatment was initiated with high doses of glucocorticoids, decreasing the size of testicular masses and testicular pain was alleviated

Presentamos el caso de un varón de 29 años diagnosticado de hiperplasia suprarrenal congénita, que fue derivado a nuestra consulta por dolor testicular, masas testiculares bilaterales y oligospermia. La ecografía confirmó la existencia de lesiones heterogéneas e hipoecoicas con bordes irregulares y vascularización interna y periférica en ambos testículos. Los marcadores tumorales séricos fueron negativos. El paciente fue programado para biopsia testicular perioperatoria y orquiectomía bilateral. La biopsia perioperatoria fue sugestiva de tumor testicular de restos suprarrenales y no se realizó ningún procedimiento adicional. Se inició tratamiento con altas dosis de glucocorticoides, disminuyó el tamaño de las masas testiculares y se alivió el dolor testicular

Tumores escrotales / Scrotal tumors

OBJETIVO: El carcinoma basocelular y el leiomioma escrotal son de presentación excepcional. Nuestro objetivo es describir tres casos de tumores escrotales y aportar información respecto a esta patología. MÉTODO: Entre 2000 y 2014, 3 pacientes fueron diagnosticados y tratados de tumor escrotal en nuestro servicio. Se revisaron las historias clínicas de dichos pacientes. RESULTADOS: Presentamos dos casos de carcinoma basocelular en varones de 72 y 71 años de edad respectivamente, que se presentaron con una lesión escrotal izquierda cuyo diagnóstico anatomopatológico tras su exerésis fue carcinoma basocelular. En un paciente, estaba afectado el borde quirúrgico y cursó con un carcinoma basocelular recurrente que fue extirpado con ampliación de bordes quirúrgicos. Describimos también un caso de leiomioma escrotal en un varón de 48 años con una lesión escrotal derecha excrecente, indolora y de bordes lisos. En el seguimiento, los pacientes continuaban clínicamente asintomáticos. CONCLUSIONES: Las lesiones escrotales en un adulto mayor deben ser extirpadas y enviadas para estudio histológico. El carcinoma basocelular de escroto se presenta como una placa, nódulo o úlcera. Precisa seguimiento y su pronóstico es bueno. El leiomioma se presenta como un nódulo no ulcerativo y su tratamiento es la extirpación completa de la lesión

OBJECTIVE: Basal cell carcinoma and leiomyoma of the scrotum are rare. We describe three cases of scrotal tumors and provide information regarding this disease. Methos: Between 2000 and 2014, 3 patients with scrotal tumors were diagnosed and treated at our institution. A review was performed using the clinical records of these patients. RESULTS: We describe two cases of basal cell carcinoma of the scrotum in men 72 and 71 year old, who presented with a left scrotal lesion that was excised and the pathological diagnosis was basal cell carcinoma. In one patient, surgical margin was affected and a recurrent basal cell carcinoma appeared. It was excised with enlargement of surgical margin. We also describe a case of scrotal leiomyoma in a 48 year old man with an elastic, firm and nontender lesion in the right scrotum. During follow-up the patients remain clinically asymptomatic. CONCLUSIONS: Scrotal lesions in the elderly should be excised and submitted for pathological examination. The basal cell carcinoma of the scrotum appears as a plaque, nodule or ulcer. Long-term surveillance is recommended for these patients. Leiomyoma of the scrotum is presented as a non-ulcerative nodule and his treatment is complete surgical excision

Tubulocystic renal carcinoma (low grade collecting duct carcinoma).

OBJECTIVE: To report a case of tubulocystic renal carcinoma diagnosed in an adult, after a work up study for hematuria. METHODS/RESULTS: 59-year-old male, CT scan was performed during a study for self-limited hematuria showing a 4.2 cm solid mass with areas suspicious of pseudocystic malignancy. Due to its debut with hematuria and renal sinus involvement laparoscopic radical nephrectomy was performed, establishing the diagnosis of tubulocystic carcinoma (low grade collecting duct carcinoma). CONCLUSION: Tubulocystic carcinoma presents histological characteristics and a natural history that makes it different from the classic type of Bellini duct carcinoma, the latter being a rapidly growing tumor with poor prognosis which is usually diagnosed in advanced stages.

Adrenal ganglioneuroma.

OBJECTIVE: To present one case of adrenal ganglioneuroma incidentally diagnosed in an adult. METHODS/RESULTS: 44-year-old woman with a 2.3 cm incidentaloma in the left adrenal gland diagnosed by CT scan. At 6 months, MRI was performed and a left adrenal nodule 3.7 cm was shown. Due to the progressive growth of the mass, surgery was indicated and left laparoscopic adrenalectomy was carried out. The final pathologic diagnosis was adrenal ganglioneuroma. CONCLUSIONS: The ganglioneuroma is a tumor composed of Schwann cells and ganglion cells. Its location in the adrenal gland is unusual, most frequently affecting other regions. Being asymptomatic lesions, they are often detected incidentally when performing imaging tests. There are radiological features that differentiate them from other adrenal masses. The treatment of choice is surgery, with adrenalectomy.

Carcinoma renal túbulo-quístico / Tubulocystic renal carcinoma (low grade collecting duct carcinoma)

OBJETIVO: Presentar el caso clínico de un carcinoma renal túbulo-quístico diagnosticado, en un adulto, tras estudio por hematuria. MÉTODO/RESULTADO: Varón de 59 años que durante un estudio por hematuria franca autolimitada se realizó un TAC que mostró una tumoración de 4,2 cm sólida con áreas pseudoquísticas sospechosa de malignidad. Debido al debut por hematuria y a la afectación del seno renal se realizó nefrectomía radical laparoscópica, estableciendo el diagnóstico de carcinoma túbulo-quístico (carcinoma de los ductos colectores de bajo grado). CONCLUSIÓN: El carcinoma túbulo-quístico presenta unas características tanto histológicas como de historia natural de la enfermedad que lo diferencia de la variante clásica del carcinoma de los ductos colectores de Bellini, siendo éste último un tumor de rápido crecimiento y mal pronóstico que suele diagnosticarse en estadios avanzados(AU)

OBJECTIVE: To report a case of tubulocystic renal carcinoma diagnosed in an adult, after a work up study for hematuria. METHODS/RESULTS: 59-year-old male, CT scan was performed during a study for self-limited hematuria showing a 4.2 cm solid mass with areas suspicious of pseudocystic malignancy. Due to its debut with hematuria and renal sinus involvement laparoscopic radical nephrectomy was performed, establishing the diagnosis of tubulocystic carcinoma (low grade collecting duct carcinoma). CONCLUSION: Tubulocystic carcinoma presents histological characteristics and a natural history that makes it different from the classic type of Bellini duct carcinoma, the latter being a rapidly growing tumor with poor prognosis which is usually diagnosed in advanced stages

Ganglioneuroma de glándula suprarrenal / Adrenal ganglioneuroma

OBJETIVO: Presentar el caso clínico de un ganglioneuroma de suprarrenal diagnosticado, en un adulto, de manera incidental. MÉTODOS/RESULTADOS: Mujer de 44 años diagnosticada de incidentaloma de 2,3 cm en la glándula suprarrenal izquierda en un TAC realizado por estudio de hemoptisis. Con estudio analítico completo de masa suprarrenal no funcionante, se realizó a los 6 meses una RMN en la que se objetiva un nódulo suprarrenal izquierdo de 3,7 cm. Ante el crecimiento progresivo de la masa se decide tratamiento quirúrgico mediante suprarrenalectomía laparoscópica izquierda, estableciendo el diagnóstico anatomopatológico definitivo de ganglioneuroma de glándula suprarrenal. CONCLUSIÓN: El Ganglioneuroma es un tumor caracterizado por una mezcla de células de Schwann y células ganglionares maduras. Su localización en la glándula suprarrenal es inusual, presentando predisposición por otras regiones. Al tratarse de lesiones asintomáticas suelen ser detectadas de manera incidental al realizar una prueba de imagen. Presenta unas características radiológicas que lo diferencian del resto de masas suprarrenales. El tratamiento es quirúrgico, mediante suprarrenalectomía (AU)

OBJECTIVE: To present one case of adrenal ganglioneuroma incidentally diagnosed in an adult. METHODS/RESULTS: 44-year-old woman with a 2.3 cm incidentaloma in the left adrenal gland diagnosed by CT scan. At 6 months, MRI was performed and a left adrenal nodule 3.7 cm was shown. Due to the progressive growth of the mass, surgery was indicated and left laparoscopic adrenalectomy was carried out. The final pathologic diagnosis was adrenal ganglioneuroma. CONCLUSIONS: The ganglioneuroma is a tumor composed of Schwann cells and ganglion cells. Its location in the adrenal gland is unusual, most frequently affecting other regions. Being asymptomatic lesions, they are often detected incidentally when performing imaging tests. There are radiological features that differentiate them from other adrenal masses. The treatment of choice is surgery, with adrenalectomy (AU)

Neuroendocrine carcinoma of the urinary bladder. 15-year retrospective analysis.

OBJECTIVES: Neuroendocrine tumors (NET) are cancers found in the bronchopulmonary tract, where they were first described in 1926. The tumors are associated with poor prognosis due to their high metastatic potency even after radical treatments associated with other neo- or adjuvant therapies. NET of the urinary bladder is a rare tumor and accounts for 0.5% of bladder tumors. METHODS: The study was designed as an observational, descriptive and retrospective study of 13 patients diagnosed, treated, and followed for NET of the urinary bladder at the Hospital and University Complex of Albacete, Albacete, Spain between 1995 and 2010. RESULTS: The sample was composed of 11 men and 2 women. Mean patient age at the time of diagnosis was 71 (range, 57-88; SD, 6.98) years. T4 (6 patients) was the most common T tumor stage, followed by T2 (5 patients) and T3 (2 patients). In the case of N tumor stage, the most common was N2. In the remaining 3 patients, the degree of lymph node involvement could not be assessed. Six presented distant metastasis at the time of diagnosis. Eleven patients presented small-cell NET on histology. Seven underwent radical surgery (radical cystectomy). All other patients were treated by deep transurethral resection of bladder tumor, except for 1 patient treated by partial cystectomy. Adjuvant chemo-therapy (usually an association of carboplatin/cisplatin and etoposide) was administered to 4 patients. Of these 4 patients, 2 were also treated by pelvic radiotherapy. Two patients survived more than 5 years following diagnosis. In fact, at the time the study data was collected only 4 patients had survived and 2 presented tumor recurrence. Of the 9 deaths, 8 occurred within 6 months of diagnosis and 1 at 24 months. All of them were the result of the disease itself. CONCLUSIONS: Neuroendocrine tumor of the urinary bladder is a rare, aggressive tumor with high metastatic potential that should be considered in the differential diagnosis of urinary bladder neoplasms. Despite various multimodality treatments have been used prognosis is poor.

Carcinoma neuroendocrino de vejiga. Analisis retrospectivo de 15 años / Neuroendocrine carcinoma of the urinary bladder. 15-year retrospective analysis

OBJETIVO: Los tumores neuroendocrinos (TNE) son tumores propios del árbol broncopulmonar, donde fueron descritos por primera vez en 1926. Son tumores de mal pronóstico debido a su gran poder metastásico aun después de tratamientos radicales asociados a otras terapias neo o adyuvantes. El TNE de vejiga representa el 0,5% de los tumores vesicales. MÉTODOS: Estudio observacional, descriptivo y retrospectivo de 13 pacientes diagnosticados, tratados y controlados por carcinoma neuroendocrino de vejiga en el Complejo Hospitalario Universitario de Albacete por el periodo entre los años 1995 y 2010. RESULTADOS: La muestra estaba formada por 11 hombres y 2 mujeres. La edad media fue de 71 años. El estadio tumoral T más frecuente hallado fue T4. El estadio tumoral N más frecuente hallado fue N2 . Seis pacientes presentaron metástasis a distancia en el momento del diagnóstico. Once pacientes presentaron histológicamente TNE de células pequeñas. A 7 pacientes se les realizó cirugía radical (cistectomía radical). La quimioterapia adyuvante se administró a 4 pacientes basada principalmente en la asociación de carboplatino/cisplatino y etopósido. A 2 de estos 4 pacientes se les administró radioterapia pélvica complementaria. La Mediana de supervivencia hallada fue de 5,1 meses. Dos pacientes presentaron supervivencia por encima de 5 años tras el diagnóstico. De los 9 éxitus letalis acontecidos, 8 de ellos se produjeron en los primeros 6 meses después del diagnóstico. El caso restante falleció a los 24 meses. Todas estas muertes fueron debidas a la propia enfermedad. CONCLUSIONES: El carcinoma neuroendocrino de vejiga es un tumor infrecuente, agresivo y con alto potencial metastásico que debe ser tenido en cuenta a la hora de realizar el diagnóstico diferencial en las neoplasias de vejiga. A pesar de utilizar distintos tratamientos multimodales el pronóstico es infausto(AU)

OBJECTIVES: Neuroendocrine tumors (NET) are cancers found in the bronchopulmonary tract, where they were first described in 1926. The tumors are associated with poor prognosis due to their high metastatic potency even after radical treatments associated with other neo- or adjuvant therapies. NET of the urinary bladder is a rare tumor and accounts for 0.5% of bladder tumors. METHODS: The study was designed as an observational, descriptive and retrospective study of 13 patients diagnosed, treated, and followed for NET of the urinary bladder at the Hospital and University Complex of Albacete, Albacete, Spain between 1995 and 2010. RESULTS: The sample was composed of 11 men and 2 women. Mean patient age at the time of diagnosis was 71 (range, 57-88; SD, 6.98) years. T4 (6 patients) was the most common T tumor stage, followed by T2 (5 patients) and T3 (2 patients). In the case of N tumor stage, the most common was N2. In the remaining 3 patients, the degree of lymph node involvement could not be assessed. Six presented distant metastasis at the time of diagnosis. Eleven patients presented small-cell NET on histology. Seven underwent radical surgery (radical cystectomy). All other patients were treated by deep transurethral resection of bladder tumor, except for 1 patient treated by partial cystectomy. Adjuvant chemo-therapy (usually an association of carboplatin/cisplatin and etoposide) was administered to 4 patients. Of these 4 patients, 2 were also treated by pelvic radiotherapy. Two patients survived more than 5 years following diagnosis. In fact, at the time the study data was collected only 4 patients had survived and 2 presented tumor recurrence. Of the 9 deaths, 8 occurred within 6 months of diagnosis and 1 at 24 months. All of them were the result of the disease itself(AU)

Vesical nephrogenic adenoma: an unusual presentation of a bladder tumour.

Vesical nephrogenic adenoma is a rare, benign entity that appears most commonly in middle-aged males. Its etiology is unknown, but it has been linked to chronic irritating factors, such as infection, trauma, urological surgery, kidney stones, foreign bodies and chemical agents, such as Bacille Calmette-Guerin. We report 2 new cases with a history of transurethral resection of the bladder and the prostate and a history of prolonged voiding symptoms. In both cases, the findings of encysted tubular structures lined with flattened cuboidal cells without atypia were consistent with the diagnosis of vesical nephrogenic adenoma.

Metástasis en la vaginal testicular de tumor mucinoso cecal primario / Metastasis to the tunica vaginalis testis from a primary mucinous tumor of the cecum

OBJETIVOS: Recordar la presencia de tumores testiculares secundarios y revisar la literatura acerca de esta patología.MÉTODOS: Presentamos un paciente con tumor mucosecretor testicular metastásico atendido en urgencias por un cuadro de escroto agudo diez meses después de ser intervenido de un tumor combinado de ciego. La aparición de este tipo de tumores es rara, y el tratamiento de elección es la orquiectomía pero aún así el pronóstico de este tipo de metástasis es malo.RESULTADOS: Los tumores mucinosos pueden presentar diseminación de modo tardío; por lo que es necesario un seguimiento a largo plazo evaluando los lugares más frecuente de asiento. El paciente falleció a los 21 meses del diagnóstico.CONCLUSIONES: La metástasis testiculares y de tumor intestinal mucosecretor son raras. Generalmente afectan a mayores de 60 años, pero también aparecen en jóvenes. Como en los tumores primarios el tratamiento es la orquiectomía(AU)

OBJECTIVES: We review the literature about secondary testicular tumors.METHODS: We present the case of a patient with a metastatic mucus-secreting testicular tumor who presented in the emergency room with symptoms of acute scrotum 10 months after surgery for a mixed tumor of the cecum. This type of tumor is rare, and the treatment of choice is orchiectomy; nevertheless, the prognosis of such metastasis remains poor.RESULTS: Because mucinous tumors can present late dissemination, long-term follow-up with assessment of the most common sites of metastasis is necessary. Our patient died 21 months after the initial diagnosisCONCLUSIONS: Testicular metastases and mucus-secreting intestinal tumor metastases are rare. These tumors occur in patients older than 60 years of age and young men. As in the case of primary tumors, the treatment is orchiectomy(AU)

Tumor testicular bilateral sincrónico de distancia histología / Bilateral synchronic testicular tumor of different histology

Objetivo: Presentar el caso de un tumor testicular germinal bilateral sincrónico de distinta histología. Método/ Resultado: Se trata de un paciente de 37 años que durante un estudio ecográfico, por sospecha de tumor testicular izquierdo, se apreció una tumoración testicular contralateral sincrónica. Se practicó orquiectomía inguinal bilateral y en el posterior estudio anatomopatológico se confirmó la presencia de la tumoración testicular bilateral de distinto componente histológico. Conclusión: Alrededor del 75% de los casos de tumoración testicular bilateral son metacrónicos, presentándose únicamente el 10% con diferente histología. El tipo histológico suele correlacionarse con el aspecto ecográfico, y el tratamiento de elección de un paciente con patología oncológica de este tipo es la orquiectomía inguinal bilateral (AU)

Objective: To report one case of bilateral synchronic germ cell testicular tumour of different histology. Methods/Results: 37-year-old patient with left testicular tumor under study was found to have a contralateral synchronic testicular tumor on ultrasound. Bilateral inguinal orchiectomy was performed and pathology reported the presence of bilateral testicular tumours of different histological type. Conclusions: Around 75% of the cases of bilateral testicular tumours are metachronic, with only 10% presenting different histology. Histological type often correlates with the ultrasound findings, and the treatment of choice in patients with this type of oncological pathology is bilateral inguinal orchiectomy (AU)

[Bellini duct carcinoma: report of two cases]. / Carcinoma de los ductos de Bellini: aportación de dos nuevos casos.

OBJECTIVE: We report two cases of collecting duct carcinoma that were diagnosed in our hospital in a six-month period. METHODS/RESULTS: The first case was a 75years-old woman showing in CT scan a mass in the left kidney which infiltrated perinephric fat. The second case was a 72-years-old that showed in a CT scan a right renal pelvis lesion, involving inferior vena cava and renal vein. After surgical resection by radical nephrectomy in both cases, we confirmed the histological diagnosis of collecting duct carcinoma. CONCLUSIONS: Collecting duct carcinoma is a rare variant of renal cell carcinoma which originates from the epithelium of the collecting tubule. It is characterized by both its aggressiveness and peculiar histological and immunohistochemical diagnosis, that separates it from the rest of renal tumors.

Implications of p53 gene mutations on patient survival in transitional cell carcinoma of the bladder: a long-term study.

OBJECTIVE: To determine the prognostic value of p53 gene mutations and P53 overexpression for predicting the incidence of recurrence, progression and long-term survival of patients with transitional cell carcinoma (TCC) of the bladder. METHODS: Prospective cohort study with 94 consecutive patients diagnosed and treated for TCC. DNA was obtained from tumor tissue to perform PCR-SSCP of p53 exons 5-9, with automatic sequencing of any mutated samples. Immunohistochemistry using anti-human P53 monoclonal antibody was also performed. Survival was analyzed and the survival curves compared (Mantel-Haenszel). Lastly, a Cox proportional hazards model was constructed. RESULTS: Mutations were found in 46.8% of samples, with 61.8% in infiltrating tumors. Exon 8 was involved in 42.3%. P53 overexpression (cutoff > or =20%) was found in 52.1%. Mean follow-up was 44.1 months; 43.6% had died by the end of this period. Mean survival was lower in patients with exon 8 mutations (38.4 months), compared with patients without this exon mutated (P = 0.016). There were no differences in patient survival based on positive or negative immunohistochemistry (cutoff > or =20%), although survival was lower in patients with a percentage higher than 50% of antibody-stained cells (P = 0.02). In the Cox analysis, tumor stage, pM stage, and interaction between stage > or =pT2 and mutated p53 gene were independent risk factors, with a 6.13-fold risk of death in these patients (P = 0.019). The number of tumors, nuclear grade, pTa stage, and the interaction between GI degree and nonmutated p53 gene remained in the Cox model for superficial tumors, such that these patients had a lower risk of recurrence or progression (P = 0.008). CONCLUSIONS: Alterations in the p53 gene may be indicative of poorer prognosis and greater recurrence in patients with urothelial bladder tumor, in particular, the presence of mutations in exon 8 and a greater percentage of stained cells in the immunohistochemistry. Nevertheless, the classic prognostic factors (primarily, pTNM stage) should still be considered the most useful factors for follow-up of these patients.

Sensitivity and specificity of p53 protein detection by immunohistochemistry in patients with urothelial bladder carcinoma.

OBJECTIVE: To analyze the correlation between the genotypic and phenotypic patterns of p53 in patients with transitional cell carcinoma (TCC) of the urinary bladder. MATERIALS AND METHODS: Cross-sectional study of 73 patients diagnosed with TCC. DNA was obtained from the tumor tissue to perform polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) of exons 5-9 of the p53 gene, with automatic sequencing done on any mutated samples. Immunohistochemistry (IHC) was also performed using anti-human P53 monoclonal antibody, and the diagnostic performance of this test was analyzed by a ROC curve, using the presence of p53 mutations found by PCR-SSCP as 'gold standard'. RESULTS: The cutoff point for defining immunopositivity was 20%. IHC had a specificity of 62.9%, and a sensitivity of 65.8%. The highest sensitivity values appeared in G3 tumors (75%) and infiltrating tumors (71.4%), and the highest specificity values were observed in G1 (77.7%) and G2 tumors (90%) and superficial tumors (66.6%). Mutations in exon 8 gave a positive result most frequently (73.7%) and were considered most relevant in terms of altering P53 function (60.9%). False negatives were documented in 28.5% of infiltrating tumors, and false positives in 33.4% of superficial tumors. CONCLUSIONS: There is a moderate correlation between p53 mutations and P53 protein overexpression, with this stronger in high-grade, infiltrating tumors, in exon 8 mutations, and when the mutation induces relevant changes in the protein structure. Although IHC is useful in routine clinical practice, the classic prognostic factors should still be considered the most important in the follow-up of these patients.

Update on the diagnosis and treatment of bladder endometriosis.

Bladder endometriosis is rare, although the bladder is the urinary tract structure most often affected by this condition. The common clinical manifestations of bladder endometriosis include menouria and urethral and pelvic pain syndrome occurring cyclically. Imaging methods are not conclusive for the definitive diagnosis. Cystoscopy is the most useful diagnostic test with confirmation by histologic study. Treatment must be individualized according to the patient's age, desire for future pregnancies, the severity of the symptoms, the site affected, and whether other organs are involved. Two types of treatment are currently used as follows: medical-hormonal and surgical.

Paraganglioma of the bladder: controversy regarding treatment.

Paragangliomas or extra-adrenal pheochromocytomas account for approximately 15% of all pheochromocytomas. They are usually found in an intradiaphragmatic location. Paragangliomas of the urinary bladder are infrequent and represent 6% of the paragangliomas and 0.06% of all bladder tumors. We describe 2 cases of urinary bladder paragangliomas attended to our center and review the literature with special attention to treatment, since there is some controversy around the management of these tumors. Surgical options include partial or total cystectomy and transurethral resection, but there is no consensus regarding these treatment modalities. The 2 patients presented underwent transurethral resection with a good outcome and no recurrence or residual disease.