[Repetition of ultrasonography-guided prostatic biopsy for the detection of cancer. Study of a series of 192 re-biopsied patients]. / Repetición de la biopsia prostática ecodirigida para la detección de cáncer. Estudio de una serie de 192 pacientes re-biopsiados.

PURPOSE: We reviewed the result of transrectal ultrasound (TRUS)-guided needle biopsies to find the re-biopsy criteria, emphasizing on the Focal Glandular Atypia (FGA) histological changes. MATERIAL AND METHOD: 192 cases were selected, from a total of 1957 patients older than 50, re-biopsied because of high PSA levels and/or abnormal DRE, or because of the histological findings on initial biopsies (high grade PIN and/or FGA). The results are related to the serum PSA levels and DRE characteristics. RESULTS: A 38.83% global positivity for cancer was obtained and 27.08% for re-biopsy. When the first biopsy was negative, the positivity of the re-biopsies was 19.37%; if it was negative for cancer but had high grade PIN and/or FGA changes, the positivity was 65.62%, being higher in FGA changes than in the PIN cases (68.00% vs. 57.14%). The abnormal DRE raised the positivity rate from 17.82% to, 35.75%. CONCLUSIONS: The positivity was especially related to abnormal DRE and/or PSA > or = 10 ng/ml. The tumor rate detected at second and third or successive biopsies was similar (19.28% vs 21.74%). The FGA changes (3.47% globally) had a cancer predictive value of 65.62%. We recommend re-biopsy in all patients with FGA changes.

[Solitary renal metastasis of primary esophageal cancer]. / Metástasis renal solitaria de un cáncer primario esofágico.

We present an unusual case of single kidney metastasis from an primary esophageal neoplasm. Its main clinical and diagnostic topics are described. They made us consider him as a good candidate for surgery. The pathological study of the nephrectomy specimen was surprising. The postoperative period was unfortunate, however.

[Testicular embryonal carcinoma with contralateral synchronous intratubular germ cell neoplasia: analysis of a case]. / Carcinoma embrionario testicular con neoplasia intratubular de células germinales sincrónica contralateral: análisis de un caso.

We report the case of a 20-year old male with a right testicular tumor. Bilateral orchidectomy was practised considering the synchronous clinical, ultrasonographical and histological (intraoperative biopsy) findings of the left testis. The definitive pathological report showed a right embryonal carcinoma with wide intratubular germ cell neoplasia (IGCN) of the contralateral testis. IGCN (formerly carcinoma in situ) is present in about 5% of cases in the contralateral gonad of those patients with a testicular neoplasm. More than 50% will develop cancer in that testis. Clinical and physical examination findings are usually unspecific. The diagnosis of IGCN is based on biopsy, although ultrasonography could give some data too, as some authors report. We analyze the therapy options for IGCN: (orchidectomy, chemotherapy, radiotherapy, or "wait and see"). In our case, the first one was made. Chemotherapy was used due to existence of retroperitoneal lymph node metastases, with an excellent follow-up afterwards.

Repetición de la biopsia prostática ecodirigida para la detección de cáncer. Estudio de una serie de 192 pacientes re-biopsiados / Repetition of prostatic ultrasound-guided biopsy for detection of cancer. Study of a serie of 192 patients re-biopsed

OBJETIVO: Se revisa el resultado de las biopsias prostáticas ecodirigidas en sextantes repetidas para establecer los criterios de re-biopsia, haciendo especial énfasis en los cambios histológicos de Atipia Glandular Focal (AGF).MATERIAL Y MÉTODO: Se seleccionan 192 casos, de una serie global de 1.957 pacientes mayores de 50 años, re-biopsiados por PSA elevado y/o TR anormal, o por los hallazgos histológicos de las biopsias inicia-les (PIN-alto grado y/o AGF). Los resultados se relacionan con los niveles de PSA sérico y con los caracteres del TR.RESULTADOS: Se obtuvo una positividad global para cáncer del 38,83 por ciento y de la re-biopsia del 27,08 por ciento. Cuando la 1ª biopsia había sido negativa, la positividad de las re-biopsias fue del 19,37 por ciento, si había sido negativa para cáncer pero con cambios de PIN-alto grado y/o AGF, la positividad fue del 65,62 por ciento, siendo mayor en los casos de AGF que en los de PIN (68,00 por ciento vs. 57,14 por ciento). El TR anormal elevó la tasa de positividad de 17,82 por ciento a 35,71 por ciento. CONCLUSIONES: La positividad estaba primordialmente relacionada con la existencia de TR anormal y/o con un PSA ≥ 10 ng/ml. Los cambios de AGF (3,47 por ciento global) han tenido un valor predictivo de cáncer del 65,62 por ciento. La tasa de tumores detectados en la 2ª biopsia, y en la 3ª o posteriores, fue similar (19,28 por ciento vs.21,74 por ciento). Se recomienda re-biopsiar a todos los pacientes con cambios de AGF (AU)

Metástasis renal solitaria de un cáncer primario esofágico / Single renal metastasis from a primary esophageal cancer

Presentamos el infrecuente caso de una metástasis renal única procedente de una neoplasia esofágica primaria. Describimos los principales aspectos clínicos y diagnósticos. Estos nos hicieron considerar al paciente como un buen candidato para cirugía. El estudio anatomopatológico de la pieza de nefrectomía fue sorprendente. El periodo postoperatorio fue, sin embargo, desafortunado (AU)

[Diffuse bladder hemangioma]. / Hemangioma vesical difuso.

Contribution of a case report of diffuse bladder haemangioma developed since childhood, focusing on the diagnosis and management of these tumours and on the pathoanatomical analysis of the lesion. Literature review.

Carcinoma embrionario testicular con neoplasia intratubular de células germinales sincrónica contralateral: análisis de un caso / Embryonal carcinoma of the testis with synchronous contralateral intretubular germ cell neoplasia: a case report

Presentamos el caso de un varón de 20 años al que le fue detectado un tumor testicular derecho, siéndole practicada orquiectomía bilateral teniendo en cuenta los hallazgos sincrónicos clínicos, ecográficos e histológicos (en biopsia intraoperatoria) del testículo izquierdo, siendo el resultado definitivo anatomopatológico de carcinoma embrionario derecho con neoplasia intratubular de células germinales (NICG) difusa del teste contralateral. La NICG (anteriormente denominada carcinoma in situ), se presenta en un 5 por ciento de casos en la gónada contralateral de aquellos pacientes con un neoplasia testicular. Más del 50 por ciento desarrollarán cáncer en dicho teste. Las manifestaciones clínicas y los hallazgos de la exploración física suelen resultar inespecíficos. El diagnóstico de NICG se basa en la biopsia, aunque la ecografía pudiera asimismo proporcionar algunos datos, según refieren algunos autores. Analizamos las opciones de cara a la terapia de la NICG: (orquiectomía, quimioterapia, radioterapia, o actitud vigilante-expectante). En nuestro caso, fue la primera la que se llevó a cabo. Debido a existencia de metástasis linfáticas retroperitoneales fue aplicado asimismo tratamiento quimioterápico, con evolución posterior excelente (AU)

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Hemangioma vesical difuso / Diffuse bladder haemangioma

Presentamos un caso de hemangioma vesical difuso evolucionado desde la infancia, haciendo hincapié en el diagnóstico y tratamiento de este tipo de tumores, así como en el análisis anatomopatológico de dicha lesión. Revisamos la literatura (AU)

[Bladder leiomyoma with extramural growth. An infrequent cause of pelvic pain]. / Leiomioma vesical de crecimiento extramural. Una causa poco frecuente de dolor pélvico.

OBJECTIVE: A case of extravesical leiomyoma that had been incidentally discovered in a patient presenting with unspecific pelvic pain is described. METHODS/RESULTS: A 51-year-old male patient consulted for unspecific pelvic pain. Patient evaluation disclosed a well-defined mass. A partial cystectomy was performed. Pathological analysis confirmed the diagnosis of leiomyoma of the bladder. CONCLUSIONS: Mesenchymal tumors of the urinary bladder are rare and account for 1%-5% of all bladder tumors. Leiomyoma is the most common benign non-epithelial tumor. The symptoms caused by this tumor type is varied, unspecific and in most of the cases depends on its location (intravesical, intramural or extramural). Treatment is by surgery, which achieves excellent results.

[Vascular assessment of the receptor before kidney transplantation]. / Evaluación vascular del receptor previa al transplante renal.

OBJECTIVES: To analyze the prevalence of vascular risk factors in patients with end-stage renal failure who are candidates to kidney transplantation, determine the efficacy of Doppler ultrasound and to develop a diagnostic vascular algorithm. METHODS: The iliac, femoral, popliteal and posterior tibial arteries of 200 potential kidney graft recipients were evaluated by Doppler US. Patients were assessed for the following risk factors: hypertension, smoking, cholesterol and triglyceride levels, and obesity. Seventy of theses patients subsequently received a kidney allograft. A biopsy of the iliac artery was performed at the level of the arteriotomy. RESULTS: Hypertension (72%), smoking (47%), obesity, hypercholesterolemia and hyperlipidemia (7%) were the most prevalent risk factors. Atherosclerosis was histologically demonstrated in 19.2%: 80% were fibrous plaques. The atherosclerotic arteries showed peak systolic and diastolic flows significantly lower than those of normal arteries (p < 0.05). The resistance index was higher in the atherosclerotic arteries (p < 0.01). The number of cigarettes (R = -0.78) and cholesterol levels (R = -0.43) correlated inversely with the peak flows in the posterior tibial artery. CONCLUSIONS: Vascular evaluation of kidney graft recipients is fundamental. Claudication, hypertension, age > 60 years, asymmetrical pulses and femorobrachial index < 0.7 are indications for performing ultrasound evaluation prior to kidney transplantation.