[Infrequent left renal pseudomass: ectopic spleen]. / Pseudomasa renal izquierda infrecuente: ectopia esplénica.

Ectopic splenic tissue is uncommon in clinical practice, usually asymptomatic and generally unsuspected diagnosed. Interest from urological point of view is due to the possibility of mimicking left renal, adrenal and retroperitoneal tumours; as well as intrapelvic, inguinal and genital masses. We report a 42-years-old female patient with pseudotumoral upper pole left kidney mass with final diagnosis of ectopic spleen. Ethiopathogenic, diagnostic and therapeutical aspects are briefly reviewed in literature. We emphasized opportunity to include ectopic splenic tissue in differential diagnosis of left renal, adrenal and retroperitoneal masses. We recommend imaging studies as CT and MRI, complemented if necessary with liver/spleen radionuclide scan. We advocate for non-aggressive attitude in selected cases with asymptomatic extrapelvic ectopic spleen under confirmed diagnosis, deferring splenectomy in symptomatic instances or secondary portal hypertension cases.

[Epistaxis as initial manifestation of disseminated renal adenocarcinoma]. / Epístaxis como primera manifestación de un adenocarcinoma renal diseminado.

Peculiar renal carcinoma tendency to unusual distant metastases suggest this primary neoplasm to be accounted in differential diagnosis of metastases as first clinical symptom of cancer. Renal cell carcinoma present metastases in 26-30% of cases at the time of diagnosis. Head and neck metastases from renal carcinoma are said to be present in 8% (6-15.2%) of patients, and half of them are asented on paranasal sinuses. We report a 70-years-old patient with recurrent epistaxis as first clinical sign of a nasosinusal metastases from renal disseminated carcinoma, who precised selective embolization. Epidemyologic, diagnostic and therapeutical aspects are briefly reviewed in literature. Nasosinusal metastases are uncommon in clinical practice. We emphasized the need of primary tumor investigation in the organs most often responsible for these metastasic deposits as: kidney (50%), lungs, breast, gastrointestinal tract, urogenital ridge and thyroid gland. Individualized treatment depends on leasions number and localization. On routine follow up of hipernephroma nephrectomized patients a high suspect index has to be considered as paranasal metastases can eventually occur.

[Metachronous contralateral Leydig cell tumor of the testis: conservative treatment]. / Tumor testicular de células de Leydig contralateral metacrónico: tratamiento conservador.

Leydig cell tumors are the primary nongerm cell tumors of the testis, comprising approximately 1 to 3% of all testicular neoplasms. These tumors are bilateral in 5 to 10% of cases. Hypoechoic testicular nodule associated to a child virilising syndrome or adult gynecomastia with negative testis tumor markers (AFP, B-HCG) show a high index suspicion for this entity. We report a case of metachronous contralateral Leydig cell tumor in a 32 years old man with a 9 year interval between presentations, in which we performed local excision of the lesion. Diagnostic an therapeutic aspects are reviewed in literature. Since preoperative diagnosis of Leydig cell tumors in difficult and clinical course unpredictible, radical orchiectomy has been the standard treatment. Emphasis is made on conservative management opportunity in patients with only one testis, small tumors (less than 2.5 cm) with biopsies from tumor bed negative and wishes to remain fertile and/or refuses androgen supplementation. Follow-up is mandatory by performing scrotal ultrasounds. CT scan, Chest X-Ray, tumor markers and hormone determinations (testosterone, estradiol, progesterone, LH and FSH).

[Large renal leiomyoma]. / Leiomioma renal voluminoso.

Renal leiomyomas are uncommon between renal tumors, and they have a benign mesenchymatous origin. Because of their low incidence, unspecific symptomatology an not well-defined iconographic semiology, they often raise problems with differential diagnosis from kidney masses, although they are often big size lessions. We report a patients with incidentally diagnosis of big solid left renal mass, who underwent radical nephrectomy resulting kidney pelvis leiomyoma. Diagnostic, histological and therapeutic aspects are briefly review in literature. Emphasis is made on the relevance of a high index suspicion considering big solid asymptomatic renal masses in middle-age women. Specially in renal tumors with well-defined limits and abscence of locoregional and systemic dissemination. We emphasized usefulness of Magnetic Angioresonance, immunohystochemical test and conservative surgery opportunity in small renal leiomyomas preoperatively confirmed.

[Giant inguinoscrotal bladder hernia associated with a bladder tumor]. / Hernia vesical inguinoescrotal gigante asociada a tumor vesical.

Inguinoscrotal bladder hernias are uncommon clinical facts more predominant in males aged between 50 and 70. This entity has no specific clinical character and diagnosis usually happens in the course of surgical repair of inguinal hernia. In about 3%-10% cases, it appears associated to inguinal hernia. Discussion of two case-reports of patients with giant inguinoscrotal bladder hernia; one patient with synchronous association to bladder transitional carcinoma. The literature on the clinical, diagnostic and therapeutic aspects is revised. The high index of suspicion for making a pre-operative diagnosis, specially in aged patients with inguinal hernia and expanded prostate signs and symptoms is highlighted. Emphasis is placed on the need for surgical hernia repair prior to prostate and/or bladder transurethral surgery.

[Testicular epidermoid cysts. Report of 2 cases]. / Quistes epidermoides testiculares. A propósito de dos observaciones.

Testicular epidermoid cysts are benign tumours which account for less than 1% of all testicular tumours. Their uncertain histogenesis, difficult pre-operative diagnosis and controversial therapeutic approach are at the base of this paper. Report on two patients, 20- and 21-year old, with testicular epidermoid cysts treated by inguinal radical orchiectomy and tumorectomy, respectively. Literature review focused on the diagnostic and therapeutic aspects. Emphasis on the relevance of ultrasound for pre-operative diagnosis. We also advocate for a conservative management if their presence is suspected or in the presence of negative tumoral markers.

[Pyourachal cyst. A diagnosis to keep in mind]. / Quiste piouracal. Un diagnóstico a tener en cuenta.

Urachal conditions are relatively exceptional, cystic formations being the most commonly reported. Urachal cysts remain silent and are not diagnosed except for the presence of associated complications such as: infection, lithiasis, re-permeabilization and malignant degeneration. This paper presents one patient with an infected urachal cyst (pyourachal) which required surgical exeresis. A literature revision is made of the clinical, diagnostic and therapeutic aspects. Emphasis is made on the relevance of a high index of suspicion considering its small incidence, the absence of specific clinical sings and the possibility of mimicking different abdominal pictures. Also the usefulness of ultrasound and computerized axial tomography in the diagnosis, and the need for surgical exeresis, including a vesical cup rim, are emphasised.

[Synchronous association of Bellini collecting ducts and pyelic transitional cell carcinoma]. / Asociación sincrónica de carcinoma de los conductos colectores de Bellini y carcinoma transicional pielico.

Bellini's collecting ducts carcinoma represent a subgroup within renal carcinoma with an incidence of 0.4 to 2% of all renal tumours. The collecting ducts share their embryological origin in Wölf's duct with the calices, renal pelvis and ureter. This common embryological origin could justify the association of carcinoma originated in the collecting ducts with transitional urothelial carcinoma. This paper contributes two patients with Bellini's collecting ducts carcinoma associated to "in situ" carcinoma and transitional papillar carcinoma in the adjacent renal pelvis respectively. The authors review the diagnostic, pathoanatomical and therapeutical aspects found in the literature. A high index of suspicion is required to diagnose a case of Bellini's carcinoma in the face of predominantly central-medullar renal solid lesions, with infiltrating growth that causes morphological changes in the excretory system without deforming the external renal outline. The authors highlight the value of immunohistochemical studies to reach a diagnosis, considering the natural history and the sombre prognosis of this uncommon renal neoplasia.

[Symptomatic renal leiomyoma]. / El leiomioma renal sintomático.

Symptomatic leiomyoma of the kidney is an uncommon, large, solitary, benign mesenchymatous tumor that must be distinguished from renal cell carcinoma. However, the diagnostic imaging techniques currently available do not permit determining the benign nature of the lesion with precision and radical excision of the compromised kidney is warranted, as in the case described herein.