[Therapeutic approach in adrenal melanoma. Review of the literature]. / Actitud terapéutica en el melanoma suprarrenal. Revisión de la literatura.

OBJECTIVE: To review the treatment strategies for adrenal melanoma and to emphasize the role of curative surgical resection and adjuvant treatment in selected patients with melanoma metastatic to the adrenal gland versus chemotherapy alone in the treatment of patients with advanced malignant melanoma. METHODS: A case of adrenal gland metastasis of a cutaneous melanoma (Clark IV, Breslow 5 mm.) treated by excision one year before that was referred to the Urology Department for Wünderlich syndrome is presented. RESULTS: The analyzed series of programmed adrenalectomy for adrenal metastases from melanoma describe survivals of 26 (3), 36 (9), 59 (3) and 72 (5) months. In our case the patient died at home one month later due to stroke, although concomitant brain metastasis is suspected. Autopsy was not performed. CONCLUSIONS: In the differential diagnosis of an incidentaloma, metastatic disease is likely in a patient with a history of malignant disease. The frequency of malignant melanoma among metastatic adrenal disease varies between 1% and 8.6%; the majority are asymptomatic and incidental findings. We believe that in selected patients with advanced malignant melanoma, with no major coexisting morbidity factors who have isolated melanoma metastatic to the adrenal gland or with limited extra-adrenal sites of disease, curative surgical resection and adjuvant treatment may improve their survival. It must be emphasized that all patients should be followed after surgical resection of the primary tumor because it will facilitate staging of the disease and avoid emergency situations of ruptured friable metastases that make complete resection difficult.

Presentación sincrónica de papiloma invertido con foco de carcinoma transicional en pelvis renal derecha y carcinoma urotelial vesical / Synchronous presentation of inverted papilloma and transitional cell carcinoma of the right renal pelvis associated to urothelial carcinoma of the bladder

Presentamos un caso de asociación sincrónica de papiloma invertido (P.I) con foco de carcinoma transicional en pelvis renal derecha (pT 2 G 1 ) y carcinoma urotelial en pared lateral izquierda de vejiga (T 1 G 2 ).El papiloma invertido urotelial es un tumor poco frecuente, generalmente benigno que constituye el 2,2 por ciento de los tumores uroteliales. Aunque su localización más frecuente es la vesical (90 por ciento), y dentro de ella en trígono y cuello, también puede aparecer en T.U.S "tracto urinario superior" (7-8 por ciento) o en uretra (3 por ciento).Aconsejamos un seguimiento cercano tras su tratamiento conservador ya que existe la posibilidad de recidivas y asociación a carcinoma transicional tanto de forma sincrónica como asincrónica (AU)

[Synchronous presentation of inverted papilloma with transitional carcinoma focus in right kidney pelvis and bladder urothelial carcinoma]. / Presentación sincrónica de papiloma invertido con foco de carcinoma transicional en pelvis renal derecha y carcinoma urotelial vesical.

We report a case with synchronous presentation of inverted papilloma (I.P) and transitional cell carcinoma of the right renal pelvis (pT2G1) associated to urothelial carcinoma on left lateral wall of the bladder (T1G2). Urothelial inverted papilloma is an uncommon, generally benign tumor that account for 2.2% of all urothelial tumors. Although the preferred location is the bladder (90%), above all in trigone and bladder neck, also can be located at the UUT "upper urinary tract" (7-8%) and urethra (3%). A close follow-up is recommended after conservative therapy, mainly endoscopic procedure, due to likelihood of recurrence and synchronous or metachronous association with transitional cell carcinoma.

[Primary neuroectodermal tumor (PNET) of the kidney: 26 cases. Current status of its diagnosis and treatment]. / Tumor neuroectodérmico primitivo renal (PNET): 26 casos. Estado actual de su diagnóstico y tratamiento.

OBJECTIVE: To report a case of primitive neuroectodermal tumor (PNET) of the kidney and review the literature and the 25 cases previously reported as PNET. METHODS: A 39-year-old man who consulted for nephric colic is described. Ultrasound evaluation disclosed a mass arising from the left kidney. The clinical, radiological and pathologic features, treatment and differential diagnosis of small cell tumors are discussed, as well as the important role of immunohistochemical techniques (positive staining with O13 or 12E7 antibodies) and cytogenetic analysis [a characteristic chromosomal translocation t(11;22) (q24;q12) or variant translocation, such as t(21;22) (q22;q12), may be detected by fluorescence in situ hybridization (FISH) or polymerase chain reaction-reverse transcriptase (PCR-RT)]. RESULTS: Survival of our patient was 20 months. Only three of the 25 previously reported cases had a longer survival: 60, 48 and 24 months. Mean survival was 10 months. 95.24% of the cases were positive for NSE. Immunostaining (CD99) was performed in 16 patients and was found to be positive in all cases. Cytogenetic and molecular analyses were performed in 11 cases; PCR-RT was negative in two, as well as in the case described herein. CONCLUSIONS: PNET is a highly aggressive neoplasm that tends to recur locally and to metastasize. Despite the poor response to standard therapy combining surgical resection, postoperative irradiation and chemotherapy, the results might change due to current research on genetic therapy based on creating antisense oligonucleotides against the EWS-FLI 1 fusion gene.