[Prostate carcinosarcoma.] / Carcinosarcoma de próstata.

OBJECTIVE: To report a new case of prostatic carcinosarcoma, an uncommon and locally and distance aggressive tumor. METHOD: We analyzed one case diagnosed in our Center, from clinical and pathological diagnosis to death, describing the treatments received. RESULT: Patient presented a huge pelvic mass and a pulmonary metastasis that was treated with cystoprostatectomy and bilateral cutaneous ureterostomy with the diagnosis of carcinosarcoma of the prostate. He received 8 cycles of Docetaxel with bone progression and then 3 cycles of doxorubicin, suspending treatment due to progression. The survival was 18 months. CONCLUSIONS: Prostate carcinosarcoma is a very aggressive neoplasia that does not respond to the usual treatments of prostate cancer.

Carcinosarcoma de próstata / Prostate carcinosarcoma

OBJETIVO: Reportar un nuevo caso de carcinosarcoma prostático, un tumor infrecuente y agresivo localmente y a distancia. MÉTODO: Se ha analizado un único caso diagnosticado en nuestro Centro, desde el diagnóstico clínico y anatomopatológico hasta el éxitus, describiéndose los tratamientos recibidos por el mismo. RESULTADO: Paciente que presenta gran masa pélvica y una metástasis pulmonar que es sometido a cistoprostatectomia y ureterostomía cutánea bilateral con el diagnóstico de carcinosarcoma de próstata. Recibió 8 ciclos de Docetaxel objetivándose progresión ósea y posteriormente 3 ciclos de Doxorrubicina suspendiéndose por progresión. La supervivencia fue de 18 meses. CONCLUSIONES: El carcinosarcoma prostático es una neoplasia muy agresiva que no responde a los tratamientos habituales del cáncer de próstata

OBJECTIVE: To report a new case of prostatic carcinosarcoma, an uncommon and locally and distance aggressive tumor. METHOD: We analyzed one case diagnosed in our Center, from clinical and pathological diagnosis to death, describing the treatments received. RESULT: Patient presented a huge pelvic mass and a pulmonary metastasis that was treated with cystoprostatectomy and bilateral cutaneous ureterostomy with the diagnosis of carcinosarcoma of the prostate. He received 8 cycles of Docetaxel with bone progression and then 3 cycles of doxorubicin, suspending treatment due to progression. The survival was 18 months. CONCLUSIONS: Prostate carcinosarcoma is a very aggressive neoplasia that does not respond to the usual treatments of prostate cancer

[Rescue cryotherapy for prostate cancer after radiotherapy]. / Crioterapia de rescate en el cáncer de próstata después de radioterapia.

Radical Radiotherapy constitutes a useful therapeutic option for localized prostate cancer. Almost one third of prostate cancer patients choose this alternative to treat the disease. Despite modifications in the technique as intensity modulation, 3D conformational radiotherapy or computer-assisted brachytherapy, a significant percentage of these patients will show an increase in PSA values after radiation. Local relapse without distant disease and PSA less than 10 ng/ml are candidates for salvage therapy. Cryotherapy has already become a curative treatment option in this group of patients. Recent technological as well as surgical advances in salvage-cryotherapy have reduced dramatically complications and progressively increase the interest on this alternative.

[Risk factors for biochemical recurrence after radical prostatectomy in patients with clinically localized prostate cancer. Implications of adjuvant treatment]. / Factores de riesgo de recidiva bioquímica después de prostatectomía radical en pacientes con cáncer de próstata clínicamente localizado. Implicaciones en el tratamiento adyuvante.

UNLABELLED: To evaluate the pathological variables predictive of biochemical recurrence after radical prostatectomy and their implications for decision making in the adjuvant setting. METHODS: 684 patients with localized prostate cancer who were treated with radical prostatectomy between 1996 and 2007. Before surgery they were classified according to D'Amico risk groups for recurrence. Following prostatectomy the following variables were collected: Gleason score, pathological stage, capsular invasion, surgical margins, perineural invasion and percentage of involvement in the piece. Univariate analysis was performed and subsequently adjusted using a Cox proportional hazards model (method enter). RESULTS: The median follow up of the series was 61 months. 29.1% of patients had biochemical recurrence. Overall mortality of the series was 4.9% and cancer-specific mortality 1.2%. In univariate analysis the Gleason score of surgical specimens, capsular invasion, perineural invasion, involvement of surgical margins, pathological stage and percentage of involvement of the piece had statistically significant (p <0.001) relation with biochemical recurrence. In multivariate analysis, a Gleason score ≥ 8 in the surgical specimen (HR = 3.08), existence of affected surgical margins (HR = 2.98), pT3 stage (HR = 1.61) and involvement of more than 50% of the piece by cancer (HR = 3.39) were identified as independent predictors of biochemical recurrence. Stratifying by independent predictors of biochemical recurrence (pT, Gleason score and margin), patients with at least 2 of these factors had an incidence of biochemical recurrence at 5 years exceeding 50%. CONCLUSIONS: Patients who have a Gleason score ≥ 8, positive margins, pT3 tumour or a percentage of >50% after prostatectomy have an increased risk of biochemical recurrence. Patients with at least 2 predictors of relapse have a probability of recurrence over 50% in the first 5 years of recurrence and should therefore be candidates for adjuvant radiotherapy.

Crioterapia de Rescate en el cáncer de próstata después de Radioterapia / Rescue cryotherapy for prostate cancer after radiotherapy

La Radioterapia es una forma de tratamiento común para el cáncer de próstata localizado. Aproximadamente 1/3 de los pacientes diagnosticados de cáncer de próstata elegirán esta opción para tratar su enfermedad. A pesar de modificaciones en la técnica como la modulación de intensidad, radioterapia conformacional 3-D, braquiterapia asistida por ordenador, un porcentaje significativo de estos pacientes mostrarán un incremento significativo posterior en los valores de PSA. La recidiva local con ausencia de enfermedad a distancia es subsidiaria de tratamiento de rescate. La crioterapia es actualmente ya una opción de intento de tratamiento curativo en pacientes con tumor comprobado por biopsia que muestran una enfermedad localizada, PSA < 10 ngrs/ml. Los avances más recientes tanto tecnológicos como técnicos de la crioterapia de rescate han reducido de forma dramática la morbilidad asociada y hacen que se incremente cada vez más el interés por esta alternativa de tratamiento en esta situación(AU)

Radical Radiotherapy constitutes a useful therapeutic option for localized prostate cancer. Almost one third of prostate cancer patients choose this alternative to treat the disease. Despite modifications in the technique as intensity modulation, 3D conformational radiotherapy or computer-assisted brachytherapy, a significant percentage of these patients will show an increase in PSA values after radiation. Local relapse without distant disease and PSA less than 10 ng/ml are candidates for salvage therapy. Cryotherapy has already become a curative treatment option in this group of patients. Recent technological as well as surgical advances in salvage-cryotherapy have reduced dramatically complications and progressively increase the interest on this alternative(AU)

Factores de riesgo de recidiva bioquímica después de prostatectomía radical en pacientes con cáncer de próstata clínicamente localizado. Implicaciones en el tratamiento adyuvante / Risk factors for biochemical recurrence after radical prostatectomy in patients with clinically localized prostate cancer. Implications of adjuvant treatment

Evaluar las variables patológicas predictivas de recidiva bioquímica después de prostatectomía radical y sus implicaciones en la toma de decisiones en el tratamiento adyuvante. MÉTODO: 684 pacientes con cáncer de próstata localizado a los que se les realizó prostatectomía radical entre 1996 y 2007. Previamente a la cirugía fueron clasificados según los grupos de riesgo de recidiva de D'Amico. Posteriormente a la prostatectomía se recogieron las siguientes variables: score de Gleason, estadio patológico, invasión capsular, márgenes quirúrgicos, invasión perineural y porcentaje de afectación en la pieza. Se realizó un análisis univariante y posteriormente se ajustó mediante un modelo de riesgos proporcionales de Cox (método enter). RESULTADOS: La mediana de seguimiento de la serie fue de 61 meses. El 29,1% de los pacientes presentaron recidiva bioquímica. La mortalidad global de la serie fue del 4,9% y del 1,2% la cáncer específica. En el análisis univariante el score de Gleason de la pieza quirúrgica, la invasión capsular, la invasión perineural, la afectación de los márgenes quirúrgicos, el estadio patológico y el porcentaje de afectación de la pieza se relacionaron de forma estadísticamente significativa (p < 0,001) con la recidiva bioquímica. En el análisis multivariante el score de Gleason ≥ 8 en la pieza quirúrgica (HR=3,08), la existencia de márgenes quirúrgicos afectados (HR=2,98), el estadio pT3 (HR=1,61) y la afectación por cáncer de más del 50% de la pieza (HR=3,39) se identificaron como variables predictivas independientes de recidiva bioquímica. Al estratificar según los factores predictivos independientes de recidiva bioquímica (pT, Gleason y margen), los pacientes con al menos 2 de estos factores presentaron una incidencia de recidiva bioquímica a los 5 años superior al 50%(AU)

CONCLUSIONES: Los pacientes que después de la prostatectomía tenían un score de Gleason ≥ 8, afectación de los márgenes, estadio pT3 o un porcentaje de tumor > 50% presentaron un riesgo aumentado de recidiva bioquímica. Los pacientes con al menos 2 factores predictores de recidiva tendrán una probabilidad de recidiva superior al 50% en los primeros 5 años de recidiva y por lo tanto deberían de ser candidatos a radioterapia adyuvante(AU)

To evaluate the pathological variables predictive of biochemical recurrence after radical prostatectomy and their implications for decision making in the adjuvant setting. METHODS: 684 patients with localized prostate cancer who were treated with radical prostatectomy between 1996 and 2007. Before surgery they were classified according to D’Amico risk groups for recurrence. Following prostatectomy the following variables were collected: Gleason score, pathological stage, capsular invasion, surgical margins, perineural invasion and percentage of involvement in the piece. Univariate analysis was performed and subsequently adjusted using a Cox proportional hazards model (method enter). RESULTS: The median follow up of the series was 61 months. 29.1% of patients had biochemical recurrence. Overall mortality of the series was 4.9% and cancer-specific mortality 1.2%. In univariate analysis the Gleason score of surgical specimens, capsular invasion, perineural invasion, involvement of surgical margins, pathological stage and percentage of involvement of the piece had statistically significant (p <0.001) relation with biochemical recurrence. In multivariate analysis, a Gleason score ≥ 8 in the surgical specimen (HR = 3.08), existence of affected surgical margins (HR = 2.98), pT3 stage (HR = 1.61) and involvement of more than 50% of the piece by cancer (HR = 3.39) were identified as independent predictors of biochemical recurrence. Stratifying by independent predictors of biochemical recurrence (pT, Gleason score and margin), patients with at least 2 of these factors had an incidence of biochemical recurrence at 5 years exceeding 50%(AU)

CONCLUSIONS: Patients who have a Gleason score ≥ 8, positive margins, pT3 tumour or a percentage of >50% after prostatectomy have an increased risk of biochemical recurrence. Patients with at least 2 predictors of relapse have a probability of recurrence over 50% in the first 5 years of recurrence and should therefore be candidates for adjuvant radiotherapy(AU)

Radical prostatectomy versus external-beam radiotherapy for localized prostate cancer: long-term effect on biochemical control-in search of the optimal treatment.

BACKGROUND: The optimal management of patients with clinically localized prostate carcinoma remains undefined due in part to the absence of well-designed, randomized trials. METHODS: This retrospective study comprised 505 patients diagnosed with low- or intermediate- risk prostate cancer in 1998-2005 and treated at Hospital Gregorio Marañón (Spain) with radical prostatectomy (RP) or external-beam radiotherapy (EBRT). No adjuvant therapy was administered. Biochemical relapse was defined as a prostate-specific antigen (PSA) level ≥0.4 ng/ml for RP cases and nadir + 2 for EBRT cases. RP was performed in 271 patients (53.6%) and EBRT in 234 patients (46.4%). The median follow-up was 60 months. The analysis end point was to compare the biochemical recurrence-free survival (bRFS) between the two groups. RESULTS: The 5-year bRFS rates for RP and EBRT were 79 ± 2% and 86 ± 2%, respectively (P = 0.48). Multivariate analysis indicated that initial PSA (P = 0.00), perineural invasion in the biopsy specimen (P = 0.00), Gleason score (P = 0.04), EBRT dose (P = 0.02), and positive margins (P = 0.00) were independent predictors of relapse. A decision tree model was constructed with these variables. In the EBRT cohort, a nadir PSA of <0.3 ng/ml was associated with the best 5-year bRFS (96.6 vs. 56.5% if nadir PSA > 1.3 ng/ml). Late biochemical failure (>5 years) was more frequent in the RT group and with low-dose EBRT (≤72 Gy). CONCLUSIONS: The biochemical failure rates were similar between PR and EBRT in low- and intermediate-risk subgroups. Outcome was determined by classic pre-treatment features, perineural invasion, low-dose EBRT (≤72 Gy), and nadir PSA value in the RT cohort.

[Mondor's syndrome. Case review and bibliographic review]. / Síndrome de Mondor. Revisión de la literatura. A propósito de un caso.

OBJECTIVE: We review the presentation, diagnosis and treatment of Mondor's disease of the penis, with the contribution of a new clinical case. METHODS: A 43-year-old male reported to the emergency room with preputial inflammation and edema associated to swelling of the dorsal region of the penis for the previous three weeks. RESULTS: Doppler ultrasound revealed thrombosis of the superficial dorsal vein of the penis, associated to candidiasic balanitis. Treatment was provided in the form of nonsteroidal antiinflammatory drugs and antibiotic and antifungal agents. The symptoms disappeared after 7 days of treatment, followed by the development of punctate phimosis that required circumcision. CONCLUSIONS: Mondor's syndrome is an infrequent condition usually caused by trauma, though it is important to consider the possibility of associated coagulation problems, infections and neoplastic processes. Doppler ultrasound is the technique of choice for confirming the diagnosis and resolution of the condition. Treatment is based on nonsteroidal antiinflammatory medication, antibiotherapy and sexual abstinence. The use of anticoagulation is controversial, but may prove useful in patients with coagulation disorders.

Síndrome de Mondor. Revisión de la literatura. A propósito de un caso / Mondor´s sindrome. Case review and bibliographic review

OBJETIVO: Revisar la forma de presentación, diagnóstico y tratamiento de la enfermedad de Mondor del pene mediante la presentación de un nuevo caso.MÉTODOS: Varón de 43 años que acude a urgencias por inflamación y edema prepucial asociado a tumefacción del dorso peneano de 3 semanas de evolución.RESULTADOS: Se realizó ecografía doppler peneana con el diagnóstico de trombosis del la vena dorsal superficial del pene, asociada a balanitis candidiásica. Se instauró tratamiento con antiinflamatorios no esteroideos, antibiótico y antifúngico. La sintomatología desapareció tras 7 días de tratamiento, con desarrollo posterior de fimosis puntiforme que requirió circuncisión. CONCLUSIONES: La enfermedad de Mondor es una patología infrecuente cuya etiología suele ser traumática, aunque es importante tener en cuenta su posible asociación a trastornos de la coagulación, infecciones y neoplasias.La técnica de elección para la confirmación del diagnostico y la resolución del cuadro es la ecografía doppler.El tratamiento se fundamenta en AINES, antibioterapia y reposo de la actividad sexual. La utilización de anticoagulantes es un aspecto controvertido, aunque de utilidad en los pacientes que presentan trastornos de la coagulación(AU)

OBJECTIVE: We review the presen-tation, diagnosis and treatment of Mondor’s disease of the penis, with the contribution of a new clinical case.METHODS: A 43-year-old male reported to the emergency room with preputial inflammation and edema associated to swelling of the dorsal region of the penis for the previous three weeks.RESULTS: Doppler ultrasound revealed thrombosis of the su-perficial dorsal vein of the penis, associated to candidiasic balanitis. Treatment was provided in the form of nonsteroidal antiinflammatory drugs and antibiotic and antifungal agents. The symptoms disappeared after 7 days of treatment, follo-wed by the development of punctate phimosis that required circumcision.CONCLUSIONS: Mondor’s syndrome is an infrequent con-dition usually caused by trauma, though it is important to consider the possibility of associated coagulation problems, infections and neoplastic processes.Doppler ultrasound is the technique of choice for confirming the diagnosis and resolution of the condition.Treatment is based on nonsteroidal antiinflammatory medica-tion, antibiotherapy and sexual abstinence. The use of anti-coagulation is controversial, but may prove useful in patients with coagulation disorders(AU)

Síndrome de Buschke-Ollendorf / Buschke-Ollendorf syndrome

Se presenta el caso de un niño de 6 años, sin antecedentes de interés, que presentaba numerosas lesiones cutáneas blanquecinas, asintomáticas, de un año de evolución, localizadas en el tronco y las extremidades, cuyo estudio histológico fue compatible con un nevo elástico. Además, el estudio radiológico mostró hallazgos de osteosclerosis. La asociación de estos hallazgos condujo al diagnóstico de síndrome de Buschke-Ollendorf. (AU)

Papilomatosis confluente y reticulada de Gougerot-Carteaud: respuesta al tratamiento con minociclina / Confluent and reticulated papillomatosis (Gougerot-Carteaud): response to treatment with minocycline

La papilomatosis confluente y reticulada es una enfermedad poco frecuente, de etiología desconocida. Clínicamente se caracteriza por presentar múltiples pápulas confluentes, marrones, de localización intermamaria e interescapular, y que posteriormente se extienden periféricamente con un patrón reticulado. Se presenta el caso clínico de un paciente afectado que se resolvió completamente tras el tratamiento con minociclina (AU)

Mastocitosis sistémica con hiperpigmentación cutánea difusa / Systemic mastocytosis: An unusual etiology for cutaneous hyperpigmentation

Presentamos un caso de mastocitosis sistémica que mostraba una importante y progresiva hiperpigmentación melánica cutánea a lo largo de los últimos 8 años. La llamativa hiperpigmentación cutánea de nuestro paciente podía estar en relación con factores estimuladores del desarrollo de mastocitos y melanocitos (AU)