[Synchronous renal clear-cell carcinoma and ipsilateral transitional-cell carcinoma: case report and bibliographic review]. / Carcinoma renal de células claras y carcinoma urotelial ipsilateral sincrónicos: aportación de un nuevo caso y revisión de la literatura.

OBJECTIVES: We report a new case of simultaneous renal cell adenocarcinoma and ipsilateral multifocal transitional cell carcinoma. METHODS: 73-year-old man with initial diagnosis of transitional cell carcinoma of the urinary tract whose pathological report showed a asynchronous renal cell carcinoma. RESULTS: We present microphotographs of both tumors after radical surgery. CONCLUSIONS: The presentation of both tumors in the same kidney is unusual, although there are around 47 cases in the bibliography worldwide, 8 of them in Spanish. Presentation of both tumors altogether does not worsen prognosis.

[A benign retroperitoneal schwannoma: a review of the literature and a report of a new case]. / Schwanoma retroperitoneal benigno: revisión de la literatura y aportación de un nuevo caso.

In a 42-years-old woman, an abdominal sonography was done, and a 10 x 9-cm solid cystic tumor on the left kidney appeared. Abdominal CT and arteriography showed a retroperitoneal heterogeneous mass surrounding and obstructing the ureteropelvic left junction. Tumor was removed under open surgery and the pathological study showed a benign schwannoma. We present this case because of its rarity 1%-10% of all primary retroperitoneal tumors.

[Female urethral caruncle. A thrombosis of the dorsal venous complex?]. / Carúncula uretral femenina. Trombosis del complejo venoso dorsal?

Five 72-86 years old women complaining of vaginal bleeding and genital discomfort during the last three weeks. Physical examination show an urethral mass of 1 cm diameter with a black, hard and painful area inside. Blood test was normal, and clinical diagnosis of caruncle urethral thrombosis was done. Topic treatment was develop with good results. We discuss the pathogenic and clinical presentation as well as the treatment of this unusual lesion.

[Renal tuberculosis associated with renal adenocarcinoma: unusual association]. / Tuberculosis renal asociada a adenocarcinoma renal: una asociación poco frecuente.

We present a patient 50 years old, complaining of right lumbar pain and miccional syndrome for three weeks. After analytic and x-ray studies, renal tuberculosis and renal cell carcinoma was the diagnosis. We started with specific antibiotic therapy and a radical nephrectomy was developed. According with the literature revised, just three cases has been published before. Because is an unusual clinic presentation we present these clinical note, we discuss the pathogenic and therapeutic procedures.

[Infiltrating bladder carcinoma: influence of complementary treatment on local control and survival]. / Carcinoma vesical infiltrante: influencia del tratamiento complementario en el control local y en la supervivencia.

We analyzed 82 patients with transitional bladder cancer stages (T2-T4) M0. According to treatment, 3 different groups were considered: Group 1: 25 patients treated with TUR and radical cystectomy. Group 2: 33 patients also received external beam radiotherapy (45-60 Gy/5 weeks) prior cystectomy. Group 3: 24 patients were also treated with intraoperative radiotherapy (15 Gy) and 3 courses of neoadjuvant chemotherapy. Our results suggest that local control rate increases significantly with the intensity of treatment (Group 3: 62% patients were PT0). Similar results were achieved in multivariate analysis. Univariate analysis of survival shows ganglionar status, vascular embolism and treatment intensity as covariates associated. Multivariate analysis demonstrate that renal function and type of complementary treatment were the covariates associated with survival. Taking both groups 2 and 3, survival was related to pathologic stage, vascular embolism and renal function. In conclusion, the significant influence of complementary treatment on the local control and survival suggest strongly their systematic utilization in infiltrating bladder cancer.

[Clinico-pathologic correlation in patients undergoing surgical staging and radical prostatectomy for prostatic cancer]. / Correlación clínicopatológica en los pacientes sometidos a estadiaje quirúrgico y prostatectomía radical por cáncer de próstata.

Presentation of our experience on the clinico-pathological staging of clinically localized prostate cancer (PCa) in 38 patients undergoing staging lymphadenectomy, 34 of which were treated with radical prostatectomy. From total number of patients, 37% were correctly staged, 60% were under-staged and only 3% were over-staged. A total of 11 patients (29%) presented nodular metastasis at the time of lymphadenectomy. Out of the 34 patients undergoing radical prostatectomy, 10 (29%) had microscopical invasion of prostatic capsule and seminal vesicles infiltration. The likelihood of nodes affectation in patients with prostatic capsule invasion and seminal vesicles infiltration was 60% and 70%, respectively. Mean PSA was significantly higher in patients with advanced disease as compared to those with disease localized in the prostatic gland. Also, mean PSA was significantly higher in patients with prostatic capsule invasion and seminal vesicles infiltration. The analysis by logistic regression identified pre-operative PSA as the only variable significantly correlated to the patient's final pathological stage.

[Retroperitoneal ganglioneuroma: an infrequent tumor]. / Ganglioneuroma retroperitoneal: un tumor infrecuente.

Presentation of 2 cases of retroperitoneal ganglioneuroma (paravertebral and adrenal, respectively), accidentally diagnosed during ultrasound study. In none of these 2 cases diagnosis by thin-needle puncture-aspiration was possible, therefore, surgical exeresis of the lesion was performed. When diagnosis is made prior to surgery, management can be conservative with close follow-up, unless neuroblastoma is identified or there is other disease-derived pathologies present.

[Pure squamous carcinoma of the ureter. Review of a case]. / Carcinoma escamoso puro de uréter. Revisión de un caso.

We report a case of squamous cell carcinoma of the ureter with periureteral infiltration. Three years following radical surgery, no evidence of tumor progression has been observed. Only 1% to 1.6% of urothelial tumors of the upper urinary tract are purely squamous cell tumors. This tumor type carries a poor prognosis. Currently, the best results can be achieved by early diagnosis and radical surgery.

[Tumor thrombosis in inferior vena cava: diagnostic imaging and therapeutic approximation]. / Trombosis tumoral en vena cava inferior (TTVCI): diagnóstico por imagen y aproximación terapéutica.

Review of our experience in the diagnosis and treatment of 44 patients with inferior vena cava tumoral thrombosis (IVCTT), associated or not to other neoplastic processes: 34 hypernephroma, 2 cava leiomyosarcoma, 1 paratesticular rhabdomyosarcoma and 1 biphasic synovial sarcoma. Twenty-five patients with hypernephroma and tumor thrombi in the ipsilateral renal vein only were excluded from the analysis since this fact did not change the usual therapeutic approach. In the 19 remaining patients, concomitantly to the primary tumour exeresis a thrombectomy was performed, using cavotomy with proximal and distal clamping in 11 patients and cardiopulmonary by-pass, deep hypothermia and cardiocirculatory arrest in 8 patients. The paper analyzes the radiological investigations performed in order to reach a IVCTT diagnosis, and reviews the related literature.

[Kidney pelvis tumor in ectopic kidney. Report of a case]. / Tumor de pelvis renal en riñón ectópico. A propósito de un caso.

A case of urothelial carcinoma in pelvic ectopic kidney is described. The low incidence of both pathologies and their rare association justifies the description.

[Infiltrating bladder carcinoma with metastatic lymph node involvement: radical treatment and survival]. / Carcinoma vesical infiltrante con afectación ganglionar metastásica: tratamiento radical y supervivencia.

Presentation of the results obtained from the study of 64 patients with T2-4 stage vesical carcinoma, treated with radical cystectomy, local lymphadenectomy, with and without complementary radiotherapy, with and without neoadjuvant chemotherapy. The univariate study of 19/64 patients with microscopic nodular disease revealed a significant relationship with the pathological stage but not with the clinical stage. The multivariate study demonstrated that the most relevant prognostic factors are a decrease in tumoral stage (P) and the presence of vascular and/or lymphatic involvement in the TUR-biopsy. The analysis of survival confirms the poor prognosis of patients with metastatic nodular involvement, in spite of the association of pelvic radiotherapy or neoadjuvant chemotherapy to the treatment.

[Tumors of the upper urothelium and cyclophosphamide: presentation of a case and review of the literature]. / Tumores de urotelio superior y ciclofosfamida: presentación de un caso y revisión de la literatura.

We report a case of upper urothelial tumor in a patient who had previously received prolonged cyclophosphamide therapy for Waldeström's macroglobulinemia. Although bladder tumors in cyclophosphamide-treated patients are relatively frequent, upper urothelial tumors are rare. Only 5 cases of this latter tumor type have been reported as of 1987. The literature on this disease entity is reviewed. Patients who have received prolonged therapy with cyclophosphamide or similar drugs must be followed very closely.

[Paratesticular rhabdomyosarcoma with intracaval neoplastic involvement: presentation of a case and review of the literature]. / Rabdomiosarcoma paratesticular con afectación tumoral intracava: presentación de un caso y revisión de la literatura.

One case of paratesticular embryonal rhabdomyosarcoma (RMS), affected during its evolution by a tumoral thrombus in the inferior vena cava. This unusual association forced the use of a cardiopulmonary by-pass, profound hypothermia and circulatory arrest, in order to carry out complete exeresis of the damage. Also, revision of the literature emphasizing that today's therapeutical approach for RMS should essentially be multidisciplinary.

[Hyperammonemia and transient blindness after transurethral resection of the prostate. Review of a case]. / Hiperamonemia y ceguera transitoria post resección transuretral de próstata. Revisión de un caso.

We report a case of hyperammonemia and transient blindness following transurethral prostatic resectin. Glicine and ammonia metabolism are reviewed. Water intoxication may not account for these symptoms.

[Uretero-iliac fistula: presentation of a case and review of the literature]. / Fístula uretero-ilíaca: presentación de un caso y revisión de la literatura.

We report a case of right common iliac artery fistula to the left ureter in a patient affected by an invasive bladder tumour treated with radical surgery, radiotherapy and neo-adjuvant chemotherapy. At the time of manifestation, our patient had indwelling catheters and presented an urinary tract infection. Diagnosis was established during autopsy. We feel that the cause of this complication is multifactorial.

[Neoadjuvant immunotherapy in non-metastatic renal adenocarcinoma]. / Inmunoterapia con fines neoadyuvantes en el adenocarcinoma renal no metastásico.

Prognostic factors were studied in 91 patients with diagnosed renal adenocarcinoma in stages pT1-4/N0-3/V0-2/M0. All patients had been treated with radical surgery, extended nephrectomy with or without cardiopulmonary by-pass and extracorporeal circulation in those cases with suprahepatic tumoral thrombosis. The tumoral features which have a significant incidence on the patient's survival rate are the degree of cellular anaplasia, GI 72% vs GII 42% vs GIII 22% (p less than 0.0001); pathological stage, pT1-2 86% vs pT3 30% (p = 0.0000), perirenal fat invasion, pT1-2 86% vs pT3a 61% (p = 0.01); renal vein or cava vein invasion, V0 72% vs V1-2 30% (p less than 0.01) and gangliar affection. N0 69% vs N1-3 11% (p = 0.0000). Development of systemic disease is significantly high in pT3 stages (p = 0.0001), mainly in pT3a (p = 0.01), N1-3 (p less than 0.05) and/or V1-2 (p = 0.01). There is premature development of metastasis conditioning death before the second year o study in 90% of patients. In our opinion, patients with renal adenocarcinoma in stages pT3a/N0/M0, pT3b/N0/M0 and pT2-4/N1-3/M0 present a high potential risk of developing metastatic disease following radical surgery. These patients, as well as those with high degree tumours and presumably minimum residual disease, are candidates for supplementary therapy with lymphokine immunotherapy (rIL-2,FNT, alpha or gamma IF, etc) with or without adoptive cellular immunotherapy (LAK or TIL) following radical surgery, and extended nephrectomy plus tumoral thrombectomy, if required, with or without cardiopulmonary bypass.

[Tumor of the upper urothelium: radical treatment and prognostic factors]. / Tumores de urotelio superior: tratamiento radical y factores pronósticos.

The paper presents the results obtained from a study of 28 patients with high urothelial tumour, treated with radical surgery (total nephroureterectomy). Multivariable study of survival rates (Cox models) indicates that cellular differentiation is the most significant prognostic factor. Single variable study indicates that tumour stage has some significance mainly due to the large relationship to the degree of cellular anaplasty.

[Cardiopulmonary by-pass with cardiac arrest and deep hypothermia for the surgical treatment of tumor thrombi in the vena cava caused by kidney carcinoma]. / By-pass cardiopulmonar con parada cardiocirculatoria e hipotermia profunda en el tratamiento quirúrgico de trombos tumorales en vena cava por carcinoma renal.

The by-pass technique with controlled cardiac arrest and hypothermia is probably the best method for an extirpation of intracava tumoral thrombi in renal tumours. The technique is easy to perform, represents a great help in the extirpation of thrombi regardless their size and location, and avoids massive bleeding.

[Stage Ta/T2 bladder tumors: prognostic and clinical course factors]. / Tumores vesicales estadío Ta/T2: factores pronóstico y progresión.

One hundred and twenty-three patients with a Ta/T2 stage vesical tumour were studied in order to identify the histological aspects associated to a tumoral behaviour particularly aggressive. The multivariate study demonstrates that those patients with a infiltrating tumour (T1-T2) or diffused urothelial dysplasia, have specially high possibilities to progress with regard to the degree of cell anaplasia (p less than 0.05); very close follow-up is needed in those patients. Likewise, patients presenting disseminated dysplastic lesions and with a history of previous urothelial tumours, progress to a new tumour stage with a significantly higher frequency (p less than 0.01); in those cases, radical surgery is the choice treatment.

[Superficial tumors of the bladder: prognostic value of the free of disease period]. / Tumores vesicales superficiales: valor pronóstico del periodo libre de enfermedad.

We study retrospectively 123 cases of patients suffering from Ta/T1/T2 vesical tumour so as to evaluate the Disease Free Period as a predictive factor of relapse potential, capability of progression and survival. This parameter has no influence over the variables that define the progression of the tumour, but it has a close correlation with relapse potential; Annual Relapse Rate (p less than 0.001) and Mean Interval between Relapses (p less than 0.0001). We were not able to show any relationship between Disease-Free Period and Survival, however it defines those tumours which relapse due to tumoural persistence. These tumours progress in stage in 80% of cases and 75% of these do so with deep tumours.