[Regression of a choroidal metastasis from prostate adenocarcinoma after hormonal therapy]. / Regresión de una metástasis coroidea de adenocarcinoma de próstata con tratamiento hormonal.

CASE REPORT: We report a case of a patient diagnosed with prostatic adenocarcinoma with multiple bone metastases and a choroidal metastasis in his left eye. Hormonal therapy with an anti-androgen and a LH-RH agonist was followed by regression of the choroidal mass over a period of 2 months. No metastatic recurrence has been demonstrated after a follow-up period of 14 months. DISCUSSION: Complete resolution of choroidal metastases of prostatic adenocarcinoma with hormonal therapy is exceptional, but the effect of this treatment on such metastases should be observed before recommending radiation therapy.

[Epithelioid hemangioendothelioma of penis]. / Hemangioendotelioma epitelioide de pene.

A case of EH of the penis in a sixtyfour-year-old patient is described. This is a rare--in this location--vascular tumor of borderline malignant potential between hemangioma and angiosarcoma. Local excision of the tumor with a cut-off of normal tissue and careful follow-up of the patient is the accepted procedure. Immunohistochemistry is essential for the diagnosis.

[Fibroepithelial polyp of the urethra in an adult]. / Pólipo fibroepitelial de uretra en un adulto.

We present the case of a fibroepithelial polyp of the prostatic urethra in a forty-five year old patient. This type of polyp is rare in the adult. The principal symptoms which the patient presented were haematuria and an intermittent reduction in micturitional flow. Endoscopic images of the tumour are shown and certain details of its histology; this is a polypoid lesion of loose connective tissue covered by typical urothelium, with occasional fascicles of smooth muscle, no prostatic-type glandular structures and no appreciable inflammatory component.

[Adrenal ectopy in epididymis]. / Ectopia adrenal en epidídimo.

OBJECTIVE: To report a case of ectopic adrenal in the epididymis. METHODS: A 17-year-old male consulted for a left varicocele and complaints referred to the right epididymis a year and a half after an episode of acute epididymitis. A nodule was excised from the epididymis. RESULTS: The pathological analysis showed an 0.4 cm nodule comprised of adrenocortical tissue. CONCLUSIONS: Ectopic adrenal cortical tissue is a benign lesion. Although routine search for this lesion is not indicated, it should be resected for histological analysis and differential diagnosis when it is found during a surgical procedure in this area.

[Suprarenal hemorrhage as the first manifestation of a small cell pulmonary carcinoma. Presentation of a case]. / Hemorragia suprarrenal como primera manifestación de un carcinoma pulmonar de células pequeñas. Presentación de un caso.

OBJECTIVE: To report on a case of small cell lung carcinoma presenting as adrenal hemorrhage. METHODS: A case of small cell lung carcinoma presenting as adrenal hemorrhage in a 60-year-old male is presented. The most important features of this tumor type and the adrenal metastasis are described. RESULTS: Treatment with carboplatin and VP-16 was unsuccessful. A brain CT scan showed several space occupying parenchymal lesions. Palliative radiotherapy was administered. The patient's condition has progressively become worse. He is currently receiving only palliative treatment. CONCLUSIONS: The adrenal gland is a common site of metastasis. One of the tumor types that frequently metastasize to the adrenals is small cell lung carcinoma, which is characterized by early local and systemic dissemination, associated paraneoplastic syndromes and its sensitivity to cytostatic agents. Adrenal metastasis from lung carcinoma should be suspected in patients with a large, heterogeneous, bilateral lesion.

[Survival in prostatic cancer, treated conservatively]. / Supervivencia del cáncer de próstata, tratado de forma conservadora.

OBJECTIVES: To analyse the survival rate among prostate cancer patients with conservative treatment. To compare survival between individuals with localised and invasive tumours, as well as between subjects below and above 70 years old at the time of diagnosis. METHODS: This study includes 80 patients diagnosed with prostate cancer between 1987 and 1988 at the Urology Service of the Central Hospital of Asturias (Spain). The cases were taken and followed retrospectively for 10 years. Kaplan Meter curves and Cox regression analyses were used for studying patients globally. Patients were categorised by tumour stage as well as by their age at the time of initial diagnosis. RESULTS: 10 patients remained living 5 years after diagnosis, corresponding to a 17% survival rate. However, 10 years after diagnosis, only 1 subject remained alive. Mean survival expressed in days was 677.28% of the cases died after the first year of diagnosis. Significant differences in survival rates were not found with regard to the age of patients ar the time of the diagnosis. However, survival is significantly higher among patients with localised tumours as opposed to invasive ones (p = 0.025; RR = 2.3). CONCLUSIONS: The survival rates is low in this study. The majority of tumours were at advanced stages when diagnosed and were mostly found in very old patients. Today, the use of PSA allows doctors to diagnose prostate cancer at earlier stages and in younger patients. This has lead to an increase in the frequency of radical prostatectomy. Future research should investigate whether this increase in radical prostatectomy has significantly changed the mortality rate of patients with prostate cancer.

[Determination of NMP-22 as recurrence marker in bladder cancer. Preliminary study]. / Determinación de NMP-22 como marcador de recidivas en el cáncer vesical. Estudio preliminar.

OBJECTIVES: The present study was conducted to determine the efficacy of NMP-22 as a diagnostic test for recurrence of bladder tumors and to compare its efficacy with urine cytology. METHODS: 30 patients (25 male, 5 female), aged 41-87 years (mean 73.4), with bladder tumor were evaluated by cytology, cystoscopy and determination of NMP-22 at 3 and 6 months post-TUR of the bladder. A positive test was defined as NMP-22 greater than 10 U/ml. RESULTS: 80.7% were T1, 15.3% T2-T3, 76.8% were grade I and II, and 23.2% were grade III. NMP-22 showed a sensitivity of 69%, a specificity of 64%, a positive predictive value of 52% and a negative predictive value of 78%, using tumor recurrence at 3 and 6 months as the unit of analysis, for a recurrence rate of 36%. Cytology showed a sensitivity of 44%, a specificity of 92%, a positive predictive value of 77% and a negative predictive value of 74%. When both tests were used, we obtained a sensitivity of 87.5%, a specificity of 64.2%, a positive predictive value of 58.3% and a negative predictive value of 90%. In grade I tumors, determination of NMP-22 had a sensitivity of 100%, a specificity of 77.7%, a positive predictive value of 60% and a negative predictive value of 69%. CONCLUSIONS: NMP-22 showed an acceptable sensitivity but a low positive predictive value, therefore control cystoscopic evaluation cannot be avoided. The sensitivity and negative predictive values increased when NMP-22 and cytology are used in combination. We found NMP-22 to be a very useful marker for recurrence of low grade tumors.

[Multiple urethral lithiasis. Report of a case]. / Litiasis uretral múltiple. A propósito de un caso.

OBJECTIVE: To report a case of multiple urethral calculi, an uncommon urological condition in our setting. The clinical, radiological and therapeutic aspects are discussed and the literature is briefly reviewed. METHODS/RESULTS: A 77-year-old male consulted at the emergency services of our hospital for dysuria, pollakiuria and difficulty in voiding. The patient also referred and indurated area in the penile ventral aspect. Radiological examination disclosed three calculi in the penile urethra with were successfully removed by meatotomty and urethrolithotomy. The patient is currently asymptomatic. CONCLUSIONS: Urethral calculus is uncommon in developed countries. "Milking" is not advocated due to the high incidence of urethral injury. Treatment is by simple urethrolithotomy in combination with other techniques (urethroplasty, diverticulectomy, etc.), if required.

[Quantification of bladder tumor antigen (BTA trak) and its correlation with bladder cancer grade and stage]. / Cuantificación del antígeno tumoral vesical (BTA trak) y su correlación con el grado y estadio del cáncer vesical.

OBJECTIVE: To analyze the efficacy of the BTA Trak test as a diagnostic marker for bladder cancer, determine its correlation with tumor grade and stage, compare its sensitivity with urinary cytology and its utility in urological conditions other than bladder cancer. METHODS: 77 patients comprised the study; 33 with bladder cancer and 44 without. A urine sample was obtained from all patients for the BTA Trak test and another three samples for urinary cytology from each of the 33 patients with bladder cancer. Of the 44 patients without bladder cancer, 36 had conditions involving the urinary tract and 8 presented conditions without urothelial involvement. The BTA Trak test was repeated three months after treatment in 11 of the patients with bladder cancer and three months after the first test in 13 patients without bladder cancer. RESULTS: Using BTA Trak threshold values of 14 U/ml as first reference and 50 U/ml as the value indicating clinical warning, these were found to be higher in 24 of 33 patients with bladder tumor (sensitivity 72.7%). By tumor stage, BTA Trak was positive in 12 of 21 pT1 (sensitivity 57%) and in 11 of 11 pT2 (sensitivity 100%). Concerning tumor grade, values were higher than threshold in 13 of 22 GI-II (sensitivity 59.9%) and 10 of 10 GIII (sensitivity 100%). Urinary cytology was positive in only 8 cases (sensitivity 24.4%). In the patients without bladder cancer, values are higher than threshold in 3 of 8 patients with urological conditions without urinary tract involvement and 14 of 36 with a probable urothelial involvement without tumor, accounting for an overall sensitivity of BTA Trak of 61.4%. The BTA Trak test three months after treatment showed lower value in 7 of 8 patients with bladder tumor and pretreatment values higher than threshold. CONCLUSIONS: The BTA Trak test is a simple quantitative method with a high sensitivity for the diagnosis of bladder tumors, especially those in the advanced stages and grades. It is superior to cytology, although it has a lower specificity, particularly in conditions with urinary tract involvement.

[Synchronous bilateral renal adenocarcinoma. Our experience with conservative kidney surgery]. / Adenocarcinoma renal bilateral sincrónico. Nuestra experiencia con la cirugía conservadora renal.

OBJECTIVE: To present our experience with synchronous bilateral renal adenocarcinoma. The indications for conservative surgery, the different types and the controversies are discussed. METHODS: 5 patients with bilateral renal adenocarcinoma from our series of 320 renal adenocarcinomas were analyzed for gender, age at presentation, tumor location, size, presenting features and type of surgery performed. RESULTS: Bilateral renal adenocarcinoma accounted for 1.56% in our series. Mean age at presentation was 57.8 years (range 43-69 years). All 5 patients were male. All patients underwent conservative surgery by tumor excision or partial nephrectomy of the side with less involvement followed by delayed radical surgery of the contralateral side. Follow-up ranged from 19 months to 14 years. To date all patients are disease-free and only one is on dialysis 14 years postoperatively. CONCLUSIONS: Bilateral renal adenocarcinoma has been reported to account for 1.4%-5% of all renal masses. The incidence in our series was 1.56%. Conservative renal surgery is indicated in patients like those described herein to prevent the need for dialysis. In our view, conservative renal surgery is a good therapeutic option that carries a small risk of tumor multicentricity and future recurrence.

[Castleman's disease in the retroperitoneal region]. / Enfermedad de Castleman de localización retroperitoneal.

OBJECTIVE: To describe a case of Castleman's disease presenting as a retroperitoneal mass, with special reference to the differential diagnosis from other retroperitoneal lesions. The histological features, variants, clinical manifestations, etiopathogenesis and treatment of Castleman's disease are reviewed. METHODS: A 64-year-old male presented with voiding symptoms and hypogastric pain. An ultrasound scan showed a 5 x 6 cm mass located behind the bladder and above the prostate, which was confirmed by an abdomino-pelvic CT scan. RESULTS: Retroperitoneal sarcoma was suspected and the mass was resected. The histopathological analysis showed giant lymphoid hyperplasia (vascular hyaline variant of Castleman's disease). CONCLUSIONS: Retroperitoneal Castleman's disease is a lymphoproliferative disorder with two well-defined histological types and a mixed variant. Although this lesion is frequently localized to the mediastinum (71%), extrathoracic lesions have been described. Definitive diagnosis is based on the postoperative pathological findings.

[Renal cell carcinoma. Clinical onset with peritoneal carcinomatosis. Report of a case]. / Carcinoma de células renales. Presentación clínica debut con carcinomatosis peritoneal. A propósito de un caso.

Renal carcinoma accounts for 2-3% of malignant tumours in the adult, with high tendency for metastasis basically in liver, lymph nodes, lungs and bones. Intraperitoneal, gut, mesentery and omentum involvement is extremely rare affecting only 1% of patients with metastasis at post-mortem. Contribution of one case of renal carcinoma with initial presentation as intraperitoneal metastasis.

[Granulomatous prostatitis. Review of 22 cases]. / Prostatitis granulomatosa. Revisión de 22 casos.

Granulomatous prostatitis is an uncommon inflammatory process of the prostate, which can be caused by a variety of infectious agents or be part of a systemic allergic condition. In most cases, origin is unspecific. Clinical presentation, treatment and evolution are similar to those of benign prostatic hypertrophy and, in many cases, can only be distinguished from prostate carcinoma in the histological study. The authors present in this paper the results and conclusions of a retrospective study of 22 cases of granulomatous prostatitis.

[Pelvic lipomatosis: cause of extrinsic ureteral obstruction. Report of a case]. / Lipomatosis pélvica, causa de obstrucción ureteral extrínseca. Presentacion de un caso.

Contribution of one case of pelvic lipomatosis, suspected through diagnostic imaging (CAT) and diagnosed by exploratory laparotomy, leading to severe unilateral ureterohydronephrosis and contralateral distal ureteral ectasia. The features of the disease, presentation form, diagnosis and treatment are discussed.

[Primary leiomyosarcoma. A rare tumor of the adrenal gland]. / Leiomiosarcoma primario. Un raro tumor de la glándula suprarrenal.

OBJECTIVE: To report on a rare case of primary leiomyosarcoma of the adrenal. To our knowledge, this is the fourth case reported in the literature. METHODS: A patient with primary leiomyosarcoma of the adrenal gland is presented. The clinical features are described, and the diagnostic and therapeutic aspects of this rare primary mesenchymal tumor are discussed. RESULTS/CONCLUSIONS: The aggressive nature and the poor prognosis of this rare tumor type are emphasized.

[Posttraumatic hematuria associated with pelvic arteriovenous fistula]. / Hematuria postraumática asociada a fístula arteriovenosa pélvica.

OBJECTIVE: To describe a patient with severe hematuria of late onset and pelvic arteriovenous fistula secondary to pelvic trauma. METHODS/RESULTS: A patient with multiple fracture of the pelvis and sacrum from a road traffic accident presented severe posttraumatic hematuria associated with pelvic arteriovenous fistula. The fistula was resolved by selective embolization and the hematuria immediately ceased. CONCLUSION: Patients with severe or long-lasting hematuria after pelvic trauma and no injuries to the urinary system, warrant arteriographic evaluation to discard vascular lesions. If present, these lesions are generally easily resolved by selective embolization.

[Epidermoid carcinoma of the penis. Review of 30 cases]. / Carcinoma epidermoide de pene. Revisión de 30 casos.

OBJECTIVE: To review our series of epidermoid carcinoma of the penis. METHODS: 30 cases of epidermoid carcinoma of the penis are reviewed. The clinical features, tumor stage, grade, treatment and outcome are analyzed. RESULTS: The time to diagnosis ranged from one month to 10 years, mean 10.3 months (1 to 36); therefore the mean diameter of the tumors was significantly greater (1.9 cm) at the time of diagnosis than at the beginning of the lesion. Eighteen patients had tumor superinfection. Twenty-four patients (80%) had low grade carcinoma; 6 had verrucous carcinoma, 6 (16.7%) intermediate and one (3.3%) high grade. Total penectomy with perineal meatus was performed in 5 cases, 23 had a partial penectomy with 2 cm margin and circumcision was done in two cases. Patients with positive lymph nodes at exploration after antibiotic treatment (13 cases) were submitted to lymphadenectomy, which was associated with chemotherapy in 4 patients. The surgical complications were mainly lymphorrhea and edema and infection of the surgical incision after lymphadenectomy. Complications at the site of penile resection were unusual. Only 6 patients have more than 5 years' follow-up (7-14), with only 1 local recurrence. The remaining patients have a mean follow-up of 22 +/- 16 months (6-60). Of these, only one patient had died from penile cancer (previously pT2pN0M0). This patient had lymph node and distant metastases 6 months following penectomy due to invasive local recurrence (pT3pN2pM1). Lymph node recurrence has been detected in three other patients. CONCLUSION: Inguinal lymphadenectomy is clearly of therapeutic value in cancer of the penis and performing it early in infiltrating tumors is likely to improve the outcome in these patients.

[Bilateral isolated infiltration in the epididymis and sperm cord as first sign of chronic lymphatic leukemia]. / Infiltración aislada bilateral de epidídimo y cordón espermático como primer signo de leucemia linfática crónica.

OBJECTIVE: Involvement of extralymphatic tissue in chronic lymphocytic leukemia (CLL) is uncommon and that of the epididymis and spermatic cord is rare. This paper describes an unusual case with metastasis to both epididymis and the spermatic cord as the first sign of reactivation of CLL. METHODS/RESULTS: A patient with CLL is described. The first sign of disease progression was the involvement of both epididymis and the spermatic cord. The literature on tumors of the epididymis and spermatic cord and CLL is briefly reviewed. CONCLUSION: Metastatic tumors of the epididymis and spermatic cord are rare. The importance of the pathological findings in making the diagnosis is underscored.

[Renal adenocarcinoma in young patients]. / Adenocarcinoma renal en pacientes jóvenes.

OBJECTIVE: To discover potential differences in known prognostic factors of renal adenocarcinoma in patients under 40 years of age. PATIENTS AND METHODS: A series of 246 patients with renal adenocarcinoma included 17 patients 40 years. Both groups were analyzed for sex, tumour size, histological characteristics and stage, examining the relative proportions within each group and looking for an association between those sets of data and age. RESULTS: No statistically significant associations were found, although it should be noted that in some cases data is incomplete. A larger proportion of low stages at least locally and a greater proportion of granule cell tumours was found in patients 40 years-old compared to those over 40. CONCLUSIONS: Existence of differences in the biological and histological characteristics of renal adenocarcinomas that develop at a younger age is not unlikely. The analysis of each factor and the survival rates in larger series should elucidate these questions, which will also be of interest to improve our understanding of the histogenesis of this type of tumours.

[Bilateral abscess of cavernous bodies]. / Absceso bilateral de cuerpos cavernosos.

Report of a rare case of abscess in both cavernous bodies. Its peculiarity is based on the location, the bilateral nature and the absence of a clear causative factor, although it was probably related of a local septic focus (rectal or prostatic). Diagnosis was established with CAT because of the primarily posterior location and the significant peripheral inflammatory reaction. The patient was treated successful with a vigorous antibiotic therapy and open drainage from both cavernous bodies with no development of sequelae such as fibrosis and penial incurvation or impotence.