Thyroid metastasis as initial presentation of clear cell renal carcinoma.

INTRODUCTION: Metastatic tumors account for 1.4-2.5% of thyroid malignancies. About 25-30% of patients with clear cell renal carcinoma (CCRC) have distant metastasis at the time of diagnosis, being the thyroid gland a rare localization [5%]. PRESENTATION OF THE CASE: A 62-year woman who underwent a cervical ultrasonography and a PAAF biopsy reporting atypical follicular proliferation with a few intranuclear vacuoles "suggestive" of thyroid papillary cancer in the context of a multinodular goiter was reported. A total thyroidectomy was performed and the histology of a clear cell renal carcinoma (CCRC) was described in four nodules of the thyroid gland. A CT scan was performed and a renal giant right tumor was found. The patient underwent an eventful radical right nephrectomy and the diagnosis of CCRC was confirmed. DISCUSSION: Thyroid metastasis (TM) from CCRC are usually apparent in a metachronic context during the follow-up of a treated primary (even many years after) but may sometimes be present at the same time than the primary renal tumor. Our case is exceptional because the TM was the first evidence of the CCRC, which was subsequently diagnosed and treated. CONCLUSION: The possibility of finding of an incidental metastatic tumor in the thyroid gland from a previous unknown and non-diganosed primary (as CCRC in our case was) is rare and account only for less than 1% of malignancies. Nonetheless, the thyroid gland is a frequent site of metastasis and the presence of "de novo" thyroid nodules in oncologic patients must be always considered and studied.

Laparoscopic approach of primary bladder endometriosis.

OBJECTIVE: To report a case of primary bladder endometriosis treated with laparoscopic partial cystectomy. METHODS: We report the case of a 38 year old woman presenting with cyclic catamenial pain and hematuria who was diagnosed of bladder endometriosis by means of cystoscopy and MRI. Partial cystectomy using a laparoscopic approach was performed and symptoms disappeared. RESULTS: We report a well-documented case of primary bladder endometriosis and the laparoscopic approach used for its treatment. A review of the concept and the therapeutic alternatives are presented. CONCLUSIONS: Bladder endometriosis must be in mind when cyclic catamenial symptoms of pain and hematuria are present. When diagnosed, the laparoscopic approach must be considered the preferential option.

Abordaje laparoscópico de la endometrosis vesical primaria / Laparoscopic approach of primary bladder endometriosis

OBJETIVO: Presentar un caso de endometriosis vesical primaria tratada mediante cistectomía parcial por vía laparoscópica. MÉTODOS: Presentamos el caso de una mujer de 38 años que se diagnóstico por cistoscopia y RNM de endometriosis vesical a raíz de presentar clínica de dolor y hematuria cíclica catamenial. Se realizó una cistectomía parcial por vía laparoscópica que fue definitiva. RESULTADOS: Presentamos un caso bien documentado de endometriosis vesical primaria y su tratamiento por vía laparoscópica, así como una revisión conceptual y de las opciones terapéuticas. CONCLUSIONES: La endometriosis vesical debe tenerse en mente ante la clínica de dolor pélvico y hematuria con perfil catamenial. Cuando se diagnóstica, el abordaje laparoscópico debe plantearse como la opción preferente

OBJECTIVE: To report a case of primary bladder endometriosis treated with laparoscopic partial cystectomy. METHODS: We report the case of a 38 year old woman presenting with cyclic catamenial pain and hematuria who was diagnosed of bladder endometriosis by means of cystoscopy and MRI. Partial cystectomy using a laparoscopic approach was performed and symptoms disappeared. RESULTS: We report a well-documented case of primary bladder endometriosis and the laparoscopic approach used for its treatment. A review of the concept and the therapeutic alternatives are presented. CONCLUSIONS: Bladder endometriosis must be in mind when cyclic catamenial symptoms of pain and hematuria are present. When diagnosed, the laparoscopic approach must be considered the preferential option

[Malacoplakia of the seminal vesicles. Case report and particularities].

OBJECTIVE: Malacoplakia is a rare chronic granulomatous disorder that mostly affects the urogenital system. This article describes a case of uncommon location of this disease at the level of the seminal vesicles and the clinical, imaging and histological particularities of this medical entity. METHOD: We report the case of a 69 year-old male consulting for constitutional syndrome that presented a pelvic tumor on the image studies, possibly arising in the seminal vesicles. RESULTS: The diagnosis was made after performing transrectal ultrasound and seminal vesicles biopsy by the pathognomonic histological findings of Michaelis Gutmann bodies. The presence of E. Coli in urine culture in our patient justified the use of a long-term antibiotic therapy such as quinolones with very good results. CONCLUSION: Malacoplakia of the seminal vesicles is an extremely rare condition, sometimes with non-specific clinical presentation. Its diagnosis is histological and it has good response to prolonged antibiotic therapy with a benign outcome.

Malacoplaquia de vesículs seminales. Presentación de un caso clínico y particularidades / Malacoplakia of the seminal vesicles. Case report and particularities

OBJETIVO: La malacoplaquia es un proceso inflamatorio granulomatoso crónico poco frecuente siendo el aparato genitourinario el asiento más frecuente de esta enfermedad. Se describe un caso que afecta a vesículas seminales con sus particularidades clínicas, diagnósticas e histológicas de esta entidad. MÉTODO: Varón, de 69 años ingresado en otro servicio por síndrome constitucional que tras la realización de pruebas de imagen (tomografía computerizada) se detecta una masa pélvica de posible origen en vesículas seminales. RESULTADOS: Se realiza ecografía transrectal y biopsia de vesículas seminales que en el estudio histológico evidencian la presencia de cuerpos de Michaelis Gutmann patognomónicos de malacoplaquia. El urocultivo fue positivo a Escherichia Coli, infección frecuentemente asociada a esta enfermedad y cuyo tratamiento de elección es la antibioterapia a largo plazo con fluoroquinolonas, que consiguió buenos resultados en nuestro caso. CONCLUSIÓN: La malacoplaquia localizada en vesículas seminales es una entidad extremadamente rara, con clínica a veces inespecífica, de diagnóstico histológico y tratamiento médico antibiótico con una evolución benigna(AU)

OBJECTIVE: Malacoplakia is a rare chronic granulomatous disorder that mostly affects the urogenital system. This article describes a case of uncommon location of this disease at the level of the seminal vesicles and the clinical, imaging and histological particularities of this medical entity. METHOD: We report the case of a 69 year-old male consulting for constitutional syndrome that presented a pelvic tumor on the image studies, possibly arising in the seminal vesicles. RESULTS: The diagnosis was made after performing transrectal ultrasound and seminal vesicles biopsy by the pathognomonic histological findings of Michaelis Gutmann bodies. The presence of E. Coli in urine culture in our patient justified the use of a long-term antibiotic therapy such as quinolones with very good results. CONCLUSION: Malacoplakia of the seminal vesicles is an extremely rare condition, sometimes with non-specific clinical presentation. Its diagnosis is histological and it has good response to prolonged antibiotic therapy with a benign outcome(AU)

Pronostico del injerto pancreático tras perdida del injerto renal por causas técnicas en el trasplante simultáneo de páncreas-riñón / Renal-pancreas transplant: prognosis of the pancreas after technical failure of the kidney

No disponible

[Intraureteral foreign body]. / Cuerpo extraño intraureteral.

OBJECTIVE: We present a rare localization for a foreing body in the urinary system, and review the bibliography to know about it existence, frequency and localization. METHODS: We present the case of a 49 year old woman who referreds she had introduced a metallic objet in her genital area. RESULTS: After the necessary tests, we could see a metallic cylinder. It was 8 cm long and was localized inside the right pelvic ureter. CONCLUSIONS: The presence of strange bodies in the urinary system is a rare urological emergency. Treatment is the key element of the extraction of the least bloody way possible.

Cuerpo extraño intraureteral / Intraureteral foreign body

OBJETIVO: Presentar una localización atípica de cuerpos extraños en el interior del aparato urinario, así como revisar en la bibliografía su existencia, frecuencia y localización.MÉTODOS: Presentamos el caso de una mujer de 49 años, que refiere la introducción de un objeto metálico en el área genital.RESULTADO: Tras la realización de las pruebas complementarias pertinentes, se objetiva un cilindro metálico de 8 cm de longitud, localizado en el interior del uréter pelviano derecho.CONCLUSIÓN: La presencia de cuerpos extraños en el interior del aparato urinario es una rara urgencia urológica, su tratamiento fundamental consiste en la extracción del elemento de la manera menos cruenta posible(AU)

OBJECTIVE: We present a rare localization for a foreing body in the urinary system, and review the bibliography to know about it existence, frequency and lo-calization.METHODS: We present the case of a 49 year old woman who referreds she had introduced a metallic objet in her genital area.RESULTS: After the necessary tests, we could see a metallic cylinder. It was 8 cm long and was localized inside the right pelvic ureter.CONCLUSIONS: The presence of strange bodies in the urinary system is a rare urological emergency. Treatment is the key element of the extraction of the least bloody way possible(AU)

[Extracorporeal shock-wave lithotripsy as treatment of lithiasis in horseshoe kidney]. / Litotricia extracorpórea por ondas de choque como tratamiento de la litiasis en riñones en herradura.

OBJECTIVES: Horseshoe kidney is the most frequent renal congenital anomaly, with an estimated general population prevalence of 1/400-500. This entity may be asymptomatic for the entire lifetime, or produce symptoms from associated complications such as lithiasis, hydronephrosis, or recurrent infections. The incidence of lithiasis varies between 20% and 80% of the patients. The treatment of lithiasis in this entity is controversial due to problems derived from the anatomy of the kidney and its drainage when stones are treated with external shock wave lithotripsy (ESWL). We tried to evaluate the efficacy of ESWL treatment and to establish the ideal conditions in which this technique may be considered treatment of choice. METHODS & RESULTS: A total of 25 patients were evaluated (17 males and 8 females). Patient age ranged from 8 to 75 year old. Three patients presented with bilateral lithiasis. 27 renal units were treated, 18 of which were left (66.7%) and 7 right. Stone size was measured in cm2 of surface. Lithiasis was located at the renal pelvis in 13 cases (48.1%), and lower calyx in 7 (25.9%). Four patients required JJ stent insertion. Mean number of shock waves per session was 3480 (range 1000-4000). Two Shock wave generators were used for treatment, the Dornier lithotripter S and the Dornier MFL-5000, with a range of 10-120 KV for the first one and 14-23 KV for the second. Follow up KUB X-rays were performed at 3, 6 and 12 months to evaluate fragmentation and elimination rates. In our series total fragmentation was 85.2%, and partial fragmentation (fragments > 6 mm) 14.8%. Elimination rates were satisfactory with 37.4% total elimination, and 48.1% partial elimination (Fragments < 6 mm). 14.8% of the patients had no elimination at all. CONCLUSIONS: We consider ESWL the first therapeutic option for cases of lithiasis with a mean area 4 cm2 or less and pelvic location. In case of great lithiasic areas other therapeutic options should be considered (open surgery or percutaneous nephrolithotomy) either in monotherapy or complementary to ESWL.

Litotricia extracorpórea por ondas de choque como tratamiento de la litiasis en riñones en herradura / External shock wave lithotripsy as treatment for lithiasis in horseshoe kidney

OBJETIVO: El riñón en herradura es la anomalía congénita renal más frecuente con una prevalencia aproximada en la población de 1 de cada 400-500 personas. Dicha entidad puede cursar de forma asintomática durante toda la vida o producir sintomatología derivada de complicaciones como litiasis, hidronefrosis e infecciones recurrentes. La incidencia de litiasis oscila entre un 20 per cent y un 80 per cent de pacientes con dicha anomalía. Se trata de un entidad en la que el tratamiento de elección de las litiasis se encuentra aún en controversia debido a los problemas derivados de la propia anatomía del riñón y su drenaje cuando las litiasis son tratadas con litotricia extracorpórea por ondas de choque (LEOC).Tratamos de evaluar la efectividad del tratamiento con LEOC estableciendo las condiciones ideales en la que dicha técnica puede ser considerada de elección en el tratamiento de estos casos. MÉTODO Y RESULTADO: Se evaluaron un total de 25 pacientes (17 varones y 8 mujeres) con edades comprendidas entre 8 y 75 años. Tres pacientes presentaron litiasis bilateral. Se trataron 27 unidades renales, de las cuales 18 fueron izquierdas (66,7 per cent) y 7 derechas. El tamaño del cálculo fue medido en cm2 de superficie. En 13 de los casos (48,1 per cent) la litiasis se localizó a nivel piélico y en 7 casos (25,9 per cent) en cáliz inferior. Cuatro pacientes requirieron la colocación de catéter doble J. El número de ondas medio por sesión fue de 3480 (rango: 1000-4000).Los generadores utilizados fueron Dornier Lithotripter S y Dornier MFL-5000, utilizando un rango de kilovoltaje de entre 10-120 en la primera y 14-23 en la segunda. Se efectuó una evaluación a los 3, 6 y 12 meses del tratamiento mediante radiografía simple de abdomen, objetivando porcentajes de fragmentación y eliminación. En nuestra serie la fragmentación total alcanzó un 85,2 per cent, quedando con fragmentación parcial (fragmentos >6 mm) un 14,8 per cent.Los porcentajes de eliminación fueron satisfactorios con un 37,4 per cent de eliminación total y una eliminación parcial (fragmentos residuales <6 mm) del 48,1 per cent. En un 14,8 per cent de pacientes no se produjo eliminación alguna. CONCLUSIONES: Consideramos la LEOC como la primera maniobra terapéutica a realizar en caso de litiasis con una superficie media menor de 4 cm2 y localización piélica. En caso de grandes superficies litiásicas deberían considerarse otras opciones terapéuticas (cirugía abierta o nefrolitotomía percutánea) como monoterapia o complementarias al tratamiento con LEOC (AU)