Liposarcoma de cordón espermático. A propósito de dos casos clínicos y revision de la literatura / Spermatic cord liposarcoma. Report of two cases and bibliographic review

OBJETIVO: Presentar dos casos de pacientes diagnosticados de liposarcoma paratesticular. Realizamos una revisión de la literatura de esta infrecuente entidad, con el fin de aclarar las características clínicas y terapéuticas. MÉTODOS: Revisión retrospectiva de la historia clínica de dos pacientes diagnosticados de liposarcoma del cordón espermático. Se revisó la epidemiología, diagnóstico, alternativas terapéuticas y el pronóstico. RESULTADOS: Caso 1: Varón de 65 años. Valorado por masa escrotal izquierda de gran tamaño 20 X 14 X 11 cm. Se le realiza una orquiectomía radical, siendo el resultado de la pieza un liposarcoma de cordón espermático bien diferenciado. Al año de seguimiento el paciente se encuentra asintomático y no se objetiva recidiva local. Caso 2: Varón de 90 años con antecedente de orquiectomía derecha por liposarcoma de cordón bien diferenciado hace 11 años, y excéresis de recidiva hace 7 años. En el seguimiento presenta una nueva recidiva tumoral a nivel inguinal, de 20 X 14 X 11 cm. Se realiza una exéresis de la masa la cual se informa como liposarcoma de cordón espermático bien diferenciado. A los 10 meses, tras la cirugía, el paciente se encuentra asintomático y sin recidiva. CONCLUSIONES: El liposarcoma es un tumor muy infrecuente y su diagnóstico se realiza anatomopatológicamente, lo que dificulta establecer pautas de tratamiento, pronóstico y diagnóstico diferencial. Al igual que en los liposarcomas de otras localizaciones es de valor pronóstico el tipo y grado histológico del tumor. La orquiectomía radical inguinal y la resección del tumor con márgenes microscópicos negativos es el tratamiento recomendado. No se ha demostrado la eficacia de tratamientos adyuvantes como la quimioterapia o radioterapia, salvo en situaciones concretas. La historia natural de la enfermedad es lenta y con escasa mortalidad, pero con una alta tasa de recidiva, por lo que un seguimiento a largo plazo es necesario

OBJECTIVE: We report two cases of patients diagnosed of paratesticular liposarcoma and perform a literature review of this rare entity. Our aim is to clarify its clinical and therapeutic characteristics. METHODS: Retrospective review of the medical records of two patients diagnosed of liposarcoma of the spermatic cord. RESULTS: Case 1: 65 year old male, presented a left large scrotal mass of 20 X 14 X 11 cm. He underwent radical orchiectomy. Pathology reported a well differentiated spermatic cord liposarcoma. After one year of follow-up the patient was asymptomatic and there was no evidence of local recurrence. Case 2: A 90 year old man, with past medical history of right orchiectomy for well-differentiated cord liposarcoma 11 years before, and excision of recurrence 7 years ago. On follow up he presented a new 20 X 14 X 11 cm inguinal tumor recurrence. We performed excision of the mass, which was reported by pathology as well differentiated spermatic cord liposarcoma. Ten months after surgery the patient was asymptomatic without recurrence. CONCLUSIONS: Liposarcoma is a very rare entity and its diagnosis is based on the pathological findings. It is therefore difficult to establish the guidelines for treatment, prognosis and differential diagnosis. As in liposarcomas in other sites, the histological type and grade of the lesion are useful for the prognosis. Radical inguinal archiectomy and resection of the tumor with a negative microscopic margin is the recommended treatment for liposarcoma of the spermatic cord. It has not been demonstrated the efficacy of adjuvant treatments such as chemotherapy or radiotherapy, except in specific situations. The natural history of disease is slow and it has low mortality, but high recurrence rate, so a long-term monitoring is necessary

[Spermatic cord liposarcoma. Report of two cases and bibliographic review.] / Liposarcoma de cordón espermático. A propósito de dos casos clínicos y revision de la literatura.

OBJECTIVE: We report two cases of patients diagnosed of paratesticular liposarcoma and perform a literature review of this rare entity. Our aim is to clarify its clinical and therapeutic characteristics. METHODS: Retrospective review of the medical records of two patients diagnosed of liposarcoma of the spermatic cord. RESULTS: Case 1: 65 year old male, presented a left large scrotal mass of 20 × 14 × 11 cm. He underwent radical orchiectomy. Pathology reported a well differentiated spermatic cord liposarcoma. After one year of follow-up the patient was asymptomatic and there was no evidence of local recurrence. Case 2: A 90 year old man, with past medical history of right orchiectomy for well-differentiated cord liposarcoma 11 years before, and excision of recurrence 7 years ago. On follow up he presented a new 20 × 14 × 11 cm inguinal tumor recurrence. We performed excision of the mass, which was reported by pathology as well differentiated spermatic cord liposarcoma. Ten months after surgery the patient was asymptomatic without recurrence. CONCLUSIONS: Liposarcoma is a very rare entity and its diagnosis is based on the pathological findings. It is therefore difficult to establish the guidelines for treatment, prognosis and differential diagnosis. As in liposarcomas in other sites, the histological type and grade of the lesion are useful for the prognosis. Radical inguinal orchiectomy and resection of the tumor with a negative microscopic margin is the recommended treatment for liposarcoma of the spermatic cord. It has not been demonstrated the efficacy of adjuvant treatments such as chemotherapy or radiotherapy, except in specific situations. The natural history of disease is slow and it has low mortality, but high recurrence rate, so a long-term monitoring is necessary.

[Urinary tract lymphoepithelial carcinoma. Report of two cases and bibliographic review.] / Carcinoma linfoepitelial del tracto urinario. Presentación de dos casos y revision de la literatura.

OBJECTIVE: We report two cases of patients diagnosed with lymphoepithelioma-like carcinomas of the urinary tract. We review the literature of this rare entity. The objective is to clarify the clinical and therapeutic characteristics. METHODS: We present a retrospective review of medical records of two patients diagnosed with lymphoepithelioma-like carcinomas, one in the renal pelvis and the other in the bladder. We review the epidemiology, diagnosis and therapeutic alternatives. RESULTS: Case 1: A 74-year-old women with past medical history of left radical nephrectomy and retroperitoneal lymphadenectomy six years before for renal pelvis carcinoma type pure lymphoepithelioma-like, stage pT4R0pN1cM0. She received adjuvant chemotherapy with Cisplatin and Gemcitabine. Five years later, she presented tumor recurrence in the left ureteral meatus, this lesion was resected. The pathology reported a high-grade urothelial carcinoma with marked lymphoid component, stage pT1. At follow-up, one year after the last recurrence, the patient was asymptomatic. In tomography control, no local or distant recurrences were objectified. Case 2: A 82-year-old men with diagnosis of muscleinvasive bladder cancer. The tumor caused right obstructive uropathy without extracapsular, regional or remote extension. We performed a radical cystoprostatectomy with bilateral pelvic lymphadenectomy and urinary diversión type cutaneous transureterostomy. The pathology reported a urothelial bladder carcinoma type mixed lymphoepithelioma-like, stage pT4aR1pN2cM0. At six months follow-up, the patient had liver and spleen lesions and retroperitoneal adenopathic nodes, all suggestive of metastases. He is currently receiving symptomatic treatment of their disease. CONCLUSIONS: We emphasize the clinical importance involved in the diagnosis of this entity. The diagnosis influence the aggressiveness of treatment and disease-specific survival. Therefore, concomitant transitional cell carcinoma defines the prognosis. The role of immunohistochemical staining is fundamental, allowing us to confirm the presence of the epithelial component.

Carcinoma linfoepitelial del tracto urinario. Presentación de dos casos y revisión de la literatura / Urinary tract lymphoepithelial carcinoma. Report of two cases and bibliographic review

OBJETIVO: Presentar dos casos de pacientes diagnosticados de carcinomas linfoepiteliales del tracto urinario. Realizamos una revisión de la literatura de esta infrecuente entidad, con el fin de aclarar las características clínicas y terapéuticas. MÉTODOS: Revisión retrospectiva de la historia clínica de dos pacientes diagnosticados de carcinomas linfoepiteliales, uno en pelvis renal y el otro en vejiga. RESULTADOS: Caso 1: Mujer de 74 años. Se le realiza una nefrectomía radical izquierda y linfadenectomía retroperitoneal por carcinoma de pelvis renal tipo linfoepitelioma like puro, estadio pT4R0pN1cM0. Recibe quimioterapia adyuvante. A los cinco años presenta recidiva tumoral en el meato ureteral izquierdo que se reseca; es informado como carcinoma uroterial de alto grado, con marcado componente linfoide, estadio pT1. Al año de seguimiento de la recidiva la paciente se encuentra asintomática y sin recaída local ni a distancia. Caso 2: Varón de 82 años diagnosticado de carcinoma vesical infiltrante. Se le realiza una cistoprostatectomía radical con linfadenectomía pélvica y derivación urinaria. El resultado es un carcinoma urotelial de vejiga tipo linfoepitelioma- like puro, estadio pT4aR1pN2cM0. A los seis meses se objetiva la aparición de metástasis de órganos sólidos y ganglionares. Actualmente se encuentra con tratamiento sintomático de su enfermedad. CONCLUSIONES: Destacar la importancia clínica que implica el diagnóstico de esta entidad, ya que puede influir en el tratamiento y la supervivencia específica de la enfermedad, siendo el carcinoma uroterial concomitante el que marque el pronóstico. El papel que desempeñan las tinciones inmunohistoquímicas es fundamental, ya que nos permiten confirmar la presencia del componente epitelial

OBJECTIVE: We report two cases of patients diagnosed with lymphoepithelioma-like carcinomas of the urinary tract. We review the literature of this rare entity. The objective is to clarify the clinical and therapeutic characteristics. METHODS: We present a retrospective review of medical records of two patients diagnosed with lymphoepitheliomalike carcinomas, one in the renal pelvis and the other in the bladder. We review the epidemiology, diagnosis and therapeutic alternatives. RESULTS: Case 1: A 74-year-old women with past medical history of left radical nephrectomy and retroperitoneal lymphadenectomy six years before for renal pelvis carcinoma type pure lymphoepithelioma-like, stage pT4R0pN1cM0. She received adjuvant chemotherapy with Cisplatin and Gemcitabine. Five years later, she presented tumor recurrence in the left ureteral meatus, this lesion was resected. The pathology reported a high-grade urothelial carcinoma with marked lymphoid component, stage pT1. At follow-up, one year after the last recurrence, the patient was asymptomatic. In tomography control, no local or distant recurrences were objectified Case 2: A 82-year-old men with diagnosis of muscleinvasive bladder cancer. The tumor caused right obstructive uropathy without extracapsular, regional or remote extension. We performed a radical cystoprostatectomy with bilateral pelvic lymphadenectomy and urinary diversión type cutaneous transureterostomy. The pathology reported a urothelial bladder carcinoma type mixed lymphoepithelioma-like, stage pT4aR1pN2cM0. At six months follow-up, the patient had liver and spleen lesions and retroperitoneal adenopathic nodes, all suggestive of metastases. He is currently receiving symptomatic treatment of their disease. CONCLUSIONS: We emphasize the clinical importance involved in the diagnosis of this entity. The diagnosis influence the aggressiveness of treatment and disease-specific survival. Therefore, concomitant transitional cell carcinoma defines the prognosis. The role of immunohistochemical staining is fundamental, allowing us to confirm the presence of the epithelial component