Valoración patológica del cáncer de próstata. Nuevos problemas / Pathological assessment of prostate cancer. New problems

Introducción: Las actuales formas de aproximación al diagnóstico y tratamiento del cáncer de próstata obliga al patólogo a un nuevo enfoque de las biopsias para proporcionar los datos exigidos por las nuevas formas de terapia. Discusión: Se explican los nuevos criterios de valoración del sistema de Gleason con la redefinición de los patrones histológicos y los grados malignidad, la incorporación de los denominados grupos pronósticos y la valoración de la masa tumoral. Conclusiones: La actualización de los conocimientos patológicos ayuda a mejorar el manejo de los pacientes, sobre todo en los casos de tumor confinado a la próstata, por la posibilidad de su terapia local

Introduction: Currently, the diagnosis and treatment of prostate cancer requires the pathologist to adopt a fresh approach to the interpretation of biopsies in order to provide the data required for the new forms of therapy. Discussion: The new evaluation criteria of the Gleason system are explained, with the redefinition of histological patterns and degree of malignancy, the incorporation of the so-called prognostic groups and the assessment of the tumour mass. Conclusions: Updating of histopathological information helps to improve patient management, especially in cases of tumour confined to the prostate, given the possibility of local therapy

[Pathological assessment of prostate cancer. New problems]. / Valoración patológica del cáncer de próstata. Nuevos problemas.

INTRODUCTION: Currently, the diagnosis and treatment of prostate cancer requires the pathologist to adopt a fresh approach to the interpretation of biopsies in order to provide the data required for the new forms of therapy. DISCUSSION: The new evaluation criteria of the Gleason system are explained, with the redefinition of histological patterns and degree of malignancy, the incorporation of the so-called prognostic groups and the assessment of the tumour mass. CONCLUSIONS: Updating of histopathological information helps to improve patient management, especially in cases of tumour confined to the prostate, given the possibility of local therapy.

Actualización del sistema Gleason y de otros datos patológicos pronósticos en el cáncer prostático: carga tumoral / Update of the Gleason system and other prognostic pathological data in prostate cancer: Tumor load

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[Update of the Gleason system and other prognostic pathological data in prostate cancer: Tumor load.] / Actualización del sistema Gleason y de otros datos patológicos pronósticos en el cáncer prostático: carga tumoral.

Desde que D. F. Gleason creara su sistema en 1966 (1 ) y que él mismo modificó en 1974 (2), su método ha sido universalmente aceptado y recomendado por la OMS (3)como factor pronóstico del carcinoma prostático (CaP). Pero, la generalización de la prueba del PSA a partir de 1979 (4), del desarrollo de la TRUS (5) y de la "biopty-gun" para la toma de biopsias en sextantes en los años 80 (6), y sus posteriores modificaciones, son hechos que han cambiado paulatinamente la postura ante el CaP y, con la experiencia adquirida, algunas de las reglas iniciales de Gleason han evolucionado. Aunque se publicaron varios estudios que proponían cambios en el sistema (7), solo los de la ISUP de 2005 (8), han tenido trascendencia real. En ellos se reconsideran algunos de los criterios para identificar aquellos tumores con un patrón histolgico de alto grado (patrón 4 o 5), redefiniendo estos patrones del sistema Gleason.

Genital self-mutilation. Case report and bibliographic review.

OBJECTIVE: To report a very uncommon case of penile open wound made by self-mutilation in a 51-year-old man, and to perform a bibliographic review. METHODS: 51-year-old man presenting at the Emergency Department under Police guard after self-cutting his penis while he was urinating, presenting an almost complete circular section that required immediate surgical repair. RESULTS: Early surgical management showed the section of almost the whole penile circumference, from ventral to dorsal, including urethra and both cavernous bodies, respecting only the dorsal vascular penile complex. We performed a primary anastomosis of the damaged structures and careful haemostasis of the penis. CONCLUSIONS: Open traumas to the penis usually require an urgent surgical examination, being mandatory to try a primary reconstruction if the global clinical situation allows it. Cosmetic and functional postoperative results advise this attitude.

Automutilación genital. Presentación de un caso clínico y revisión de la literatura / Genital self-mutilation. Case report and bibliographic review

OBJETIVO: Presentar un caso clínico muy poco frecuente de herida abierta del pene producida por automutilación, así como revisar la literatura principal existente sobre este tipo de traumatismo infrecuente.MÉTODO: Varón de 51 años de edad que acude al Servicio de Urgencias custodiado por el Cuerpo Nacional de Policía tras haberse autoinfringido un corte en el pene mientras orinaba, que le causó una sección circunferencial del pene casi completa, y que requirió revisión quirúrgica urgente. RESULTADO: La intervención quirúrgica puso de manifiesto la sección de prácticamente toda la circunferencia peneana, de ventral a dorsal, incluyendo uretra y ambos cuerpos cavernosos y respetando tan sólo el complejo vascular dorsal del pene. En dicho acto se procedió a la anastomosis primaria de las estructuras seccionadas y a la hemostasia cuidadosa de los vasos sangrantes.CONCLUSIONES: Las heridas abiertas del pene requieren generalmente revisión quirúrgica urgente, debiendo intentarse la reconstrucción primaria si la situación clínica lo permite, dados los buenos resultados estéticos y funcionales logrados tras la cirugía (AU)

OBJECTIVE: To report a very uncommon case of penile auto-mutilation in a 51-year-old man, self-made with a biting object.METHODS: 51-year-old man presenting at the Emergency Department guarded by the Police after auto-cutting his penile while he was urinating, causing him an almost complete circular section that required immediate surgical management.RESULTS: early surgical management showed the section of almost the whole penile circumference, from ventral to dorsal, including the urethra and both cavernous bodies, respecting only dorsal vascular penile complex. We performed a primary anastomosis of damaged structures and carefully haemostasis of the penis.CONCLUSIONS: open traumas to the penis usually require an urgent surgical examination, being mandatory to try a primary reconstruction if global clinical situation allows it. Cosmetic and functional postoperative results advise this attitude (AU)

Bladder hernia.

OBJECTIVE: To report a new case of bladder hernia. We reviewed the clinical features, diagnosis and treatment of this disease. METHODS: Case report of a patient diagnosed with bladder hernia. RESULTS: We expose the clinical picture and the most common form of diagnosis and the more effective treatment. CONCLUSIONS: Bladder hernia is rare disorder that is diagnosed clinically and whose treatment is surgical, with very good results.

Hernia vesical / Bladder hernia

OBJETIVO: Aportar un nuevo caso de hernia vesical. Revisamos los aspectos clínicos, diagnósticos y terapéuticos de este tipo de patología.MÉTODOS: Caso clínico de un paciente diagnosticado de hernia vesical.RESULTADO: Exponer la clínica más frecuente así como la forma de diagnóstico y tratamiento más efectiva.CONCLUSIONES: La hernia vesical es una patología poco frecuente que se diagnostica de forma clínica y cuyo tratamiento de elección es quirúrgico, con muy buenos resultados(AU)

OBJECTIVE: To report a new case of bladder hernia. We reviewed the clinical features, diagnosis and treatment of this disease.METHODS: Case report of a patient diagnosed with bladder hernia.RESULTS: We expose the clinical picture and the most common form of diagnosis and the more effective treatment.CONCLUSIONS: Bladder hernia is rare disorder that is diagnosed clinically and whose treatment is surgical, with very good results(AU)

[Cystic displasia of the testis. Review of literature]. / Displasia quística de rete testis: revisión de la literatura.

OBJECTIVE: Review this pathology nowadays. METHODS: We search in Medline/PubMed database for reviews about cystic dysplasia of the testis. We review and discuss the relevant literature about it. RESULTS: Cystic dysplasia of the testis (CDT) is a rare benign disease, associated with upper urinary tract malformations. Its most frequent clinical manifestation is the increase of testicular size; the presence of cysts is demonstrated by ultrasound. No consensus exists in its treatment, it oftenly requires histological confirmation, performing testicle-sparing surgery. CONCLUSION: CDT needs to be taken into account in the differential diagnosis of childhood testicular tumors.

Displasia quística de rete testis: revisión de la literatura / Cystic displasia of the testis. Review of literature

Objetivo: Revisión de la Displasia Quística de Rete Testis en el momento actual. Material y Métodos: Búsqueda bibliográfica en la base de datos Medline/PubMed del término “Cystic dysplasia of the testis”, con análisis de las revisiones bibliográficas encontradas. Resultados: La displasia quística de rete testis (DQRT) es una rara enfermedad benigna, asociada a malformaciones del tracto urinario superior. Su manifestación clínica más frecuente es el aumento de tamaño testicular, demostrándose la presencia de los quistes ecográficamente. No existe consenso en el tratamiento, optándose en la mayoría de los casos por la confirmación anatomopatológica con conservación del parénquima testicular. Conclusión: La DQRT es una enfermedad que debe ser tenida en cuenta en el diagnóstico diferencial de la masa escrotal infantil (AU)

Objetive: Review this pathology nowadays. Methods: We search in Medline/PubMed database for reviews about cystic dysplasia of the testis. We review and discuss the relevant literature about it. Results: Cystic dysplasia of the testis (CDT) is a rare benign disease, associated with upper urinary tract malformations. Its most frequent clinical manifestation is the increase of testicular size; the presence of cysts is demonstrated by ultrasound. No consensus exists in its treatment, it oftenly requires histological confirmation, performing testicle-sparing surgery. Conclusion: CDT needs to be taken into account in the differential diagnosis of childhood testicular tumors (AU)

[Immunosuppression and surgical complications after renal transplantation]. / Inmunosupresión y complicaciones quirúrgicas post-trasplante renal.

OBJECTIVES: The new immunosuppressive regimens in kidney transplantation have diminished the rate of acute rejection and improved graft survival. However, the use of new agents results in the development of surgical complications. The authors analyze the incidence of such complications accordingly to the type of drug. METHODS: This study included 350 kidney transplantations performed between January 1997 and December 2004. The average age was 54 years. The incidence of diabetes mellitus was 8.5% and the rate of obese recipients (BMI >30 kg/m2) was 15.4%. The average follow-up rate was 44 +/- 5.6 months (5-96). A surgical complication was defined as any complication directly related to the surgical transplant that occurs along the first year after transplantation. RESULTS: The incidence of surgical complications was 34.8% (122/350). The rates of perigraft collections and bleeding posttransplant were significantly higher in the CsA group than in the Tacro one: 12% vs. 3.8% (p = 0.005) and 11.5% vs. 3% (p = 0.002). The Sirolimus and Everolimus-based immunosuppresive regimens led to a higher incidence of lymphocele (16% vs. 3.7%) (p = 0.012). There were no significant difference in the incidence of surgical complications in recipients immunosuppressed with and without MMF, and in diabetic vs. no diabetic patients. Surgical complications were higher in obese patients (66.5% vs. 33.5%) (p = 0.002). CONCLUSIONS: Recipients receiving Sirolimus/Everolimus demonstrated a significantly higher lymphocele rate. The CsA regimens were associated with bleeding and post transplant pararenal fluid collections. The introduction of MMF did not result in a significant increase in posttransplant surgical complications. The obesity was a risk factor associated with those complications.

Inmunosupresión y complicaciones quirúrgicas post-trasplante renal / Immunosuppression and surgical complications after renal transplantation

OBJETIVO: Los nuevos inmunosupresores disminuyen las tasas de rechazo agudo en el transplante renal y mejoran la supervivencia del injerto, aunque modifican la incidencia y tipo de complicaciones quirúrgicas. En este estudio se analiza la incidencia de complicaciones quirúrgicas postransplante renal según el tipo de inmunosupresión recibida. MÉTODOS: Desde enero de 1997 a diciembre de 2004 se han realizado 350 transplantes renales, con edad media de los pacientes de 54.6+/- 6.2 años y tiempo medio de seguimiento de 44+/-5.6 meses. Son diabéticos 30 pacientes (8.5%) y obesos 54 (15.4%) con Índice de Masa Corporal (IMC) media de 32.2+/- 6.5 kg/m2. Definimos complicación quirúrgica a cualquier complicación directamente relacionada con el acto quirúrgico durante el primer año tras la intervención. RESULTADOS: Se objetivan un 34.8% de complicaciones generales (122/350). Las complicaciones más frecuentes son las fístulas (7%), estenosis (6.5%), colección (6%), hemorragia (5.7%), complicaciones vasculares (5.1%) y de herida quirúrgica (4.6%). La incidencia de complicaciones quirúrgicas fue semejante para las pautas con y sin MMF. Los tratados con CsA presentan 45.4% de complicaciones frente a los tratados con Tacro que tienen un 30%, con significación estadística para hematoma (3.6% vs. 0.4%, p<0.05), linfocele (8.2% vs. 2.1%, p<0.05), y hemorragia (11.8% vs. 2.9%, p<0.05). La tasa de complicaciones en los tratados con inhibidores mTOR en comparación con los no tratados es del 44% vs. 34.1%, con significación estadística para linfocele (16% vs. 5.2%, p<0.05). El 66.5% de los pacientes obesos presentan complicaciones (p<0.05). CONCLUSIONES: El uso de CsA se asocia a mayor tasa de colecciones (hematoma/linfocele) y hemorragia; los inhibidores de mTOR aumentan el riesgo de linfoceles postransplante; el MMF no aumenta de forma significativa el porcentaje de complicaciones quirúrgicas. La obesidad es un factor de riesgo para las complicaciones quirúrgicas en los pacientes transplantados

OBJECTIVES: The new immunosuppressive regimens in kidney transplantation have diminished the rate of acute rejection and improved graft survival. However, the use of new agents results in the development of surgical complications. The authors analyze the incidence of such complications accordingly to the type of drug. METHODS: This study included 350 kidney transplantations performed between January 1997 and December 2004. The average age was 54 years. The incidence of diabetes mellitus was 8.5% and the rate of obese recipients (BMI> 30 kg/m2) was 15.4%. The average follow-up rate was 44+/- 5.6 months (5-96). A surgical complication was defined as any complication directly related to the surgical transplant that occurs along the first year after transplantation. RESULTS: The incidence of surgical complications was 34.8% (122/350). The rates of perigraft collections and bleeding posttransplant were significantly higher in the CsA group than in the Tacro one: 12% vs. 3.8% (p=0.005) and 11.5% vs. 3% (p=0.002). The Sirolimus and Everolimus-based immunosuppresive regimens led to a higher incidence of lymphocele (16% vs. 3.7%) (p= 0.012). There were no significant difference in the incidence of surgical complications in recipients immunosuppressed with and without MMF, and in diabetic vs. no diabetic patients. Surgical complications were higher in obese patients (66.5% vs. 33.5%) (p= 0.002). CONCLUSIONS: Recipients receiving Sirolimus/Everolimus demonstrated a significantly higher lymphocele rate. The CsA regimens were associated with bleeding and post transplant pararenal fluid collections. The introduction of MMF did not result in a significant increase in posttransplant surgical complications. The obesity was a risk factor associated with those complications

[Ultrasonography for the study of small renal masses]. / Estudio ultrasonográfico de las masas renales de pequeño tamaño.

OBJECTIVES: To perform an update on the usefulness of ultrasound in the study of small size renal tumors and its current possibilities. METHODS: We review the results of ultrasound in this pathology with the addition of the most recent technological advances such as a harmonic digital converters and power color Doppler. We analyze its contribution to the differential diagnosis of the cystic pathology, to the definition of solid masses, to the detection and characterization of small size masses, and to the definition of the vascular patterns of various tumors. RESULTS: Ultrasonography offers a diagnostic safety of 98% in cystic masses, being able to detect them from 0.5 cm diameter in favourable conditions. The differential diagnosis of multiloculated masses, multivesicular hydatid cyst, multiloculated cystic nephroma, and multiloculated cystic carcinoma still poses great difficulty, the same way it happens with other radiological tests. For solid masses, the greater image resolution has lead to a progressive increase in the incidental detection of tumors and the percentage of patients candidates to conservative surgery due to the decrease in size. It is easy to differentiate between adenocarcinoma and angiomyolipoma, up to 85% of the cases, but the rest of the tumors do not have specific characteristics. For small size masses, smaller than 3 cm, ultrasound sensitivity is clearly inferior to CT scan. Power color Doppler helps to confirm the existence of solid masses and helps a better differential diagnosis with pseudo tumors. CONCLUSIONS: The modern ultrasound techniques provide a high cost-effectiveness both in detection and definition of the nature of small size renal masses.

[Diagnosis and follow-up of benign prostatic hyperplasia by ultrasound]. / Diagnóstico y seguimiento de la hipertrofia prostática benigna mediante ecografía.

OBJECTIVES: The aim of the study is to analyze the utility of ultrasound in the evaluation and treatment selection of patients with benign prostatic hyperplasia (BPH). METHODS: A total of 5000 patients older than 50 years and with prostatic symptoms were evaluated with abdominal ultrasound and in selected cases with transrectal ultrasound. RESULTS: The first ultrasonographic sign of BPH is the increase of anteroposterior and longitudinal diameters. Prostatic volume is measured with a safety of 80%, post-void volume and indirect signs of bladder obstruction are also determined by ultrasound. Upper urinary tract pathological conditions can be also detected. CONCLUSIONS: Ultrasound associated with PSA and urinary flow are adequate to evaluate and select treatment in patients with BPH.

[Testicular ultrasonography]. / Ecografía testicular.

OBJECTIVES: To review the contribution of ultrasound to the differential diagnosis of scrotal pathology, both testicular and adnexal. METHODS: We performed a bibliographic review on the topic, adding the experience of our Unit over the years; we classified the pathology in testicular and extratesticular, separating liquid and solid lesions, and a miscellaneous group of unclassifiable cases. RESULTS: Currently, ultrasonography with high frequency equipment allows not only to differentiate between intra and extratesticular lesions, but also to identify specific lesions, the manage of which may include follow-up without need of unavoidable surgery. CONCLUSIONS: Ultrasonography is a painless simple test that may be repeated without inconvenience so that it is the first test to be indicated for any problem of the scrotal content.

Estudio ultrasonográfico de las masas renales de pequeño tamaño / Ultrasonography for the study of small renal masses

OBJETIVO: Efectuar una puesta al día de la utilidad de la ecografía en el estudio de los tumores renales de pequeño tamaño y de las posibilidades que esta técnica ofrece en el momento actual. MÉTODO: Revisión de los resultados obtenidos en esta patología con las aportaciones ofrecidas por los desarrollos tecnológicos más recientes como los convertidores digitales con modo armónico y el Doppler color energía. Análisis de su contribución al diagnóstico diferencial con la patología quística, a la definición de las masas sólidas, a la detección y caracterización de las masas de pequeño tamaño y a la definición de los patrones vasculares de los diferentes tumores. RESULTADOS: La ecografía ofrece una seguridad diagnóstica del 98% en las masas quísticas pudiéndose objetivar en condiciones favorables a partir de un diámetro de 0,5 cm. El diagnóstico diferencial de las masas multitabicadas, quiste hidatídico multivesicular, nefroma quístico multilocular y carcinoma quístico multilocular, sigue planteando graves dificultades, al igual que ocurre con el resto de las técnicas de imagen. En las masas sólidas la mayor resolución de las imágenes ha conducido a un incremento progresivo en la detección de tumores incidentales y en el porcentaje de pacientes candidatos a cirugía conservadora dada la continua disminución en su tamaño. La diferenciación entre el adenocarcinoma y el angiomiolipoma es fácil y posible en el 85% de los casos no presentando el resto de tumores características específicas. En las masas de pequeño tamaño, menores de 3 cm., la sensibilidad de esta técnica es claramente inferior a la de la TAC. El Doppler color energía ayuda a confirmar la existencia de las masas sólidas y permite un mejor diagnóstico diferencial con los seudotumores. CONCLUSIONES: Las modernas técnicas ecográficas ofrecen una elevada rentabilidad tanto en la detección como en la definición de la naturaleza de las masas renales de pequeño tamaño

OBJECTIVES: To perform an update on the usefulness of ultrasound in the study of small size renal tumors and its current possibilities. METHODS: We review the results of ultrasound in this pathology with the addition of the most recent technological advances such as a harmonic digital converters and power color Doppler. We analyze its contribution to the differential diagnosis of the cystic pathology, to the definition of solid masses, to the detection and characterization of small size masses, and to the definition of the vascular patterns of various tumors. RESULTS: Ultrasonography offers a diagnostic safety of 98% in cystic masses, being able to detect them from 0.5 cm diameter in favourable conditions. The differential diagnosis of multiloculated masses, multivesicular hydatid cyst, multiloculated cystic nephroma, and multiloculated cystic carcinoma still poses great difficulty, the same way it happens with other radiological tests. For solid masses, the greater image resolution has lead to a progressive increase in the incidental detection of tumors and the percentage of patients candidates to conservative surgery due to the decrease in size. It is easy to differentiate between adenocarcinoma and angiomyolipoma, up to 85% of the cases, but the rest of the tumors do not have specific characteristics. For small size masses, smaller than 3 cm, ultrasound sensitivity is clearly inferior to CT scan. Power color Doppler helps to confirm the existence of solid masses and helps a better differential diagnosis with pseudo tumors. CONCLUSIONS: The modern ultrasound techniques provide a high cost-effectiveness both in detection and definition of the nature of small size renal masses

Diagnóstico y seguimiento de la hipertrofia prostática benigna mediante ecografía / Diagnosis and follow-up of benign prostatic hyperplasia by ultrasound

OBJETIVO: La finalidad del estudio es analizar la utilidad de la ecografía en la evaluación, elección del tratamiento y seguimiento del paciente con una hiperplasia prostática benigna (HPB). MÉTODOS: Se estudiaron 5.000 pacientes de edad > 50 años con clínica de prostatismo mediante ecografía abdominal y en casos seleccionados transrectal. RESULTADOS: El signo ecográfico más precoz de la HPB es el incremento de los diámetros anteroposterior y longitudinal de la próstata. La ecografía tiene una seguridad del 80% en la evaluación del volumen prostático y permite medir el residuo postmiccional, así corno datos indirectos de obstrucción del músculo detrusor vesical. Finalmente, posibilita la detección de patología asociada en el tracto urinario superior. CONCLUSIONES: la ecografía en colaboración con el PSA y la flujometría permite evaluar y seleccionar el tratamiento en el paciente con HPB

OBJECTIVES: the aim of the study is to analyze the utility of ultrasound in the evaluation and treatment selection of patients with benign prostatic hyperplasia (BPH). METHODS: a total of 5000 patients older than 50 years and with prostatic symptoms were evaluated with abdominal ultrasound and in selected cases with transrectal ultrasound. RESULTS: the first ultrasonographic sign of BPH is the increase of anteroposterior and longitudinal diameters. Prostatic volume is measured with a safety of 80%, post-void volume and indirect signs of bladder obstruction are also determined by ultrasound. Upper urinary tract pathological conditions can be also detected. CONCLUSIONS: ultrasound associated with PSA and urinary flow are adequate to evaluate and select treatment in patients with BPH

Ecografía testicular / No disponible

OBJETIVO: Se pretende revisar la aportación de la ecografía al diagnóstico diferencial de la patología escrotal tanto testicular como anexial. MÉTODO: se ha realizado una revisión bibliográfica sobre el tema incorporando la experiencia de nuestra Unidad a lo largo de los años, clasificando la patología en testicular y extratesticular y dentro de estas separando aquellas lesiones líquidas de las sólidas, además de un grupo de miscelánea no clasificable. RESULTADOS: actualmente la ecografía con equipos de alta frecuencia permite no sólo diferenciar entre patología intra y extraescrotal sino identificar lesiones específicas cuyo manejo puede incluir el seguimiento sin tener que recurrir a la exploración quirúrgica inevitable. CONCLUSIONES: la ecografía es una prueba sencilla, no dolorosa y puede repetirse sin mayor inconveniente por lo que es la primera prueba que debe solicitarse ante cualquier problema del contenido escrotal

OBJECTIVES: To review the contribution of ultrasound to the differential diagnosis of scrotal pathology, both testicular and adnexal. METHODS: We performed a bibliographic review on the topic, adding the experience of our Unit over the years; we classified the pathology in testicular and extratesticular, separating liquid and solid lesions, and a miscellaneous group of unclassifiable cases. RESULTS: Currently, ultrasonography with high frequency equipment allows not only to differentiate between intra and extratesticular lesions, but also to identify specific lesions, the manage of which may include follow-up without need of unavoidable surgery. CONCLUSIONS: Ultrasonography is a painless simple test that may be repeated without inconvenience so that it is the first test to be indicated for any problem of the scrotal content

Actualización de la clasificación de la OMS de los tumores del urotelio superior / No disponible

No disponible