Genetic counseling in prostate cancer: How to implement it in daily clinical practice? / Asesoramiento genético en cáncer de próstata: ¿cómo implementarlo en la práctica clínica diaria?

Prostate cancer plays an undeniably prominent role in public health in our days and health systems. Its epidemiological impact is quantitatively very close to that of other tumors such as colon cancer and breast cancer, in which genetic counseling is part of their routine clinical practice, both in the initial evaluation and in the selection of therapeutic strategies. Hereditary cancer syndromes, breast/ovarian and Lynch syndrome are part of genetic counseling in these tumors. Currently, we also know that they can be associated to prostate cancer. The time has come to implement genetic counseling in prostate cancer from the earliest stages of its approach, from initial suspicion to the most advanced tumors. We present an updated review carried out by our interdisciplinary working group on scientific literature, clinical practice guidelines and consensus documents, aimed at the creation and drafting of a'Protocol for genetic counseling in prostate cancer' for the study of germline, with easy application in different healthcare settings. This protocol is currently being implemented in our routine practice and provides answers to 3 specific questions: Who should receive genetic counseling for prostate cancer? Which gene panel should be analyzed? How should counseling be done according to the results obtained? Other aspects about who should perform genetic counseling, ethical considerations and regulations are also collected.

A Preliminary Study of the Ability of the 4Kscore test, the Prostate Cancer Prevention Trial-Risk Calculator and the European Research Screening Prostate-Risk Calculator for Predicting High-Grade Prostate Cancer.

INTRODUCTION: To prevent the overdiagnosis and overtreatment of prostate cancer (PC), therapeutic strategies have been established such as active surveillance and focal therapy, as well as methods for clarifying the diagnosis of high-grade prostate cancer (HGPC) (defined as a Gleason score ≥7), such as multiparametric magnetic resonance imaging and new markers such as the 4Kscore test (4KsT). By means of a pilot study, we aim to test the ability of the 4KsT to identify HGPC in prostate biopsies (Bx) and compare the test with other multivariate prognostic models such as the Prostate Cancer Prevention Trial Risk Calculator 2.0 (PCPTRC 2.0) and the European Research Screening Prostate Cancer Risk Calculator 4 (ERSPC-RC 4). MATERIAL AND METHODS: Fifty-one patients underwent a prostate Bx according to standard clinical practice, with a minimum of 10 cores. The diagnosis of HGPC was agreed upon by 4 uropathologists. We compared the predictions from the various models by using the Mann-Whitney U test, area under the ROC curve (AUC) (DeLong test), probability density function (PDF), box plots and clinical utility curves. RESULTS: Forty-three percent of the patients had PC, and 23.5% had HGPC. The medians of probability for the 4KsT, PCPTRC 2.0 and ERSPC-RC 4 were significantly different between the patients with HGPC and those without HGPC (p≤.022) and were more differentiated in the case of 4KsT (51.5% for HGPC [25-75 percentile: 25-80.5%] vs. 16% [P 25-75: 8-26.5%] for non-HGPC; p=.002). All models presented AUCs above 0.7, with no significant differences between any of them and 4KsT (p≥.20). The PDF and box plots showed good discriminative ability, especially in the ERSPC-RC 4 and 4KsT models. The utility curves showed how a cutoff of 9% for 4KsT identified all cases of HGPC and provided a 22% savings in biopsies, which is similar to what occurs with the ERSPC-RC 4 models and a cutoff of 3%. CONCLUSIONS: The assessed predictive models offer good discriminative ability for HGPCs in Bx. The 4KsT is a good classification model as a whole, followed by ERSPC-RC 4 and PCPTRC 2.0. The clinical utility curves help suggest cutoff points for clinical decisions: 9% for 4KsT and 3% for ERSPC-RC 4. This preliminary study should be interpreted with caution due to its limited sample size.

Un nuevo caso de histiocitoma fibroso maligno dependiente de cápsula renal / A new case of malignant fibrous histiocytoma arising from the renal capsule

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Expresion del receptor de esteroides y xenobioticos (SXR) y del gen de multirresistencia drogas (MDR1) y de los polimorfismos de las enzimas GSTs, SULTs y CYP en tumores vesicales profundos, analisis de su expresion y correlación con otros factores pronósticos / Steroid and xenobiotic receptor (SXR), multidrug resistance gene (MDR1) and GSTs, SULTs and CYP polymorphism expression in invasive bladder cancer, analysis of their expression and correlation with other prognostic factors

Introducción: El receptor de esteroides y xenobióticos SXR se ha demostrado su activación por parte de numerosos medicamentos, incluidos potentes inductores del citocromo P450, como la rifampicina y el cotrimazol. La función del SXR es bien conocida, y consiste en regular de manera positiva la trascripción del citocromo P450 3A4 (CYP3A4) y el gen de multirresistencia a drogas (multidrug resistance gene) MDR1, se considera una llave clave en el mecanismo regulador del metabolismo de los xenobióticos encontrándose involucrado en todas las fases de detoxificación Múltiples enzimas involucradas en el metabolismo y la degradación de hidrocarburos policíclicos aromáticos (PAH) son polimórficas en humanos, incluyendo la glutation S-transferasa (GSTs), N-acetiltransferasa (NATs), sulfotransferas (SULTs)1A1 y el citocromo p450 (CYP)1B1. Objetivos: Los objetivos que nos hemos planteado son los siguientes: 1. Analizar la expresión del factor de trascripción SXR y del MDR1 en vejiga mediante RT-PCR en tiempo real, tanto en vejiga tumoral como vejiga normal. 2. Analizar la relación de los factores clínicos y patológicos con la expresión del SXR y del MDR1. 3. Analizar la expresión de los polimorfismos de CYP1B1, GSTM1 GSTT1 y SULT1A1, y su correlación con distintos factores clínico patológicos y moleculares. Material y Métodos: De manera prospectiva se calculó un tamaño muestral necesario para este estudio. Se incluyeron 67 pacientes de dos instituciones distintas (Hospital Universitario Miguel Servet (49 HUMS) y Clínica Universitaria de Navarra (18 CUN)), diagnosticados de cáncer vesical infiltrante y tratados mediante cistectomía radical, se le realizó la determinación de la expresión de SXR y MDR1 mediante PCR cuantitativa en tiempo real, así como de los polimorfismos CYP1B1, GSTM1 GSTT1 y SULT1A1 mediante RFLP (restricción de la longitud del fragmento del polimorfismo). Se correlaciona mediante tablas de contingencia la correlación con el resto de los factores pronósticos. Resultados: La media de seguimiento de los pacientes fue de 23,7 meses, con una mediana de 28,26 meses. De los 67 pacientes estudiados, 31 pacientes (46,3%) presentaron progresión de la enfermedad, bien en forma de recidiva local, metástasis a distancia o ambos, con un tiempo medio a recidiva de 12,4 meses, mediana de 10 meses, con un rango de 1,1 mes a 31,9 meses. 36 pacientes (53,7%) no presentaron evidencia de progresión de la enfermedad. El receptor de esteroides y xenobióticos SXR así como el gen de multirresistenia a drogas (Multidrug resistance gene (MDR1)), se expresan en vejiga normal (0,94ΔCt y 0,94ΔCt) y en vejiga tumoral de la pieza de cistectomía (1,09 ΔCt y 0,45 ΔCt). Hemos analizado su expresión de manera cuantitativa y de manera cualitativa. La expresión de SXR se correlaciona con la presencia de carcinoma in situ (p=0,024), infiltración vasculo-linfática (p=0,05) mientras que MDR1 se correlaciona con la presencia de infiltración vasculo linfática (p=0,05) A su vez ambos la presencia de ambos factores se correlaciona entre ellos (p=0,011) Los polimorfismos: CYP1B1, GSTM1, GSTT1 y SULT1A1, se expresan en vejiga pero su expresión no guarda correlación con ningún factor pronóstico Conclusiones: El SXR y el MDR1 se expresan tanto en vejiga normal y tumoral. Y que dicha expresión guarda una correlación con factores pronósticos con influencia en la supervivencia descritas en la literatura

Introduction: Steroid and Xenobiotic Receptor (SXR) has demonstrated its activation by numerous drugs, including cytochrome P450 potent inducers like rifampicina or cotrimazol. The role of SXR is well known, and lies regulating in a positive manner cytochrome P450 3A4 (CYP3A4) transcription and the multidrug resistance gene (MDR1), it’s considered a key in the xenobiotic detoxification mechanism, being involved in all phases of the detoxification process. Enzymes involved in Policyclic Aromatic hidrocarbures (PAH) metabolism and degradation are polymorphic in humans, including glutation S-transferases (GSTs), N-acetiltransferases (NATs), sulfotransferases (SULTs)1A1 and cytochrome p450 (CYP)1B1. Objectives: The objectives we’ve planned are: 1. Analyze the expression of the transcription factor SXR and MDR1 in bladder by means of RT-PCR real time, both in normal bladder and in tumoral bladder. 2. Analyze the relation between clinical and pathological factors with the expression of SXR and MDR1. 3. Analyze the expression of the polymorphims CYP1B1, GSTM1 GSTT1 and SULT1A1 and their correlation with different clinic-pathological and molecular factors. Material and Methods: In a prospective way the size of the sample was estimated. In 67 patients from two institutions (Hospital Universitario Miguel Servet (49 HUMS) and Clinica Universitaria de Navarra (18 CUN)), diagnosed of invasive bladder cancer and treated by means of radical cystectomy, were determined the expression of both SXR and MDR1 by means of real time PCR, as well as the polymorphisms CYP1B1, GSTM1 GSTT1 y SULT1A1 by means of RFLP (Restriction fragment length polymorphism). Correlations with other prognostic factors by contingency tables were performed. Results: Average follow up was 23,7 months with a median of 28,26 months. Of the 67 patients studied, 31 patients (46,3) presented disease progression, in form of local recurrence or in distant metastasis or both. With a average time to progression of 12,4 months and a median of 10 months, with a range of 1,1 month to 31,9 month. 36 patients (53,7%) did not have any evidence of disease progression during follow up. The Steroid and Xenobiotic Receptor as well as the Multidrug Resistance Gene (MDR1) are expressed in both normal bladder (0,94ΔCt y 0,94ΔCt) and tumoral bladder in the cystectomy specimen(1,09 ΔCt y 0,45 ΔCt). We’ve analyzed their expression in a quantitative manner and in a qualitative manner. The expression of SXR correlates with the presence of ca. in situ (p=0,024), vasculo-lymphatic invasion (p=0,05) mean while MDR1 correlates with presence of vasculo-lymphatic invasion (p=0,05) Both factors are correlate between each others (p=0,011). Polymorphisms: CYP1B1, GSTM1, GSTT1 and SULT1A1, are expressed in these patients but their expression doesn’t correlates with any prognostic factor Conclusions: Both SXR and MDR1 are expressed in normal bladder as well as in tumoral bladder. And their expression correlates with different prognostic factors with influence in the survival described in the literature

[Are there any differences between the characteristics and the behavior of bladder cancer according to the age of presentation? Our experience]. / Existen diferencias en las caracteristicas y en el comportamiento del tumor vesical según edad de presentación? Nuestra experiencia.

INTRODUCTION: Owing to the different results from the series that evaluate the behavior of the bladder cancer according to the age at the moment of the diagnosis, our objective is based on valuing the characteristics and behaviour according to age of appearance. METHODS: A retrospective study of bladder cancer diagnosed in our area during decade 1993-2003, distributed in 3 intervals of age and some characteristics and behaviour are valued. RESULTS: Elderly patients present greater tumors, non differentiated and with greater rate of progression to infiltrated. Moreover the age, the pathological stage and the tumorlike degree appear as independent significant factors in the multivariant study. CONCLUSIONS: In our experience, the patients greater than 70 years present neoplasms of similar clinical characteristics, although pathologically more aggressive, with greater percentage of progression and worse survival.

¿Existen diferencias en las características y en el comportamiento del tumor vesical según edad de presentación? Nuestra experiencia / Are there any differences between the characteristics and the bahavior of bladder cancer according to the age of presentation? our experience

Objetivo: Dados los diferentes resultados de las series que evalúan el comportamiento de los tumores vesicales según la edad en la que debutan, nuestro objetivo se basa en valorar las características y comportamiento según edad de aparición. Método: Se realiza un estudio retrospectivo de los tumores vesicales de nuevo diagnóstico de nuestra área durante el decenio 1993-2003, distribuidos en 3 intervalos etarios y se evalúan diferentes características y comportamiento. Resultados: Se demuestra que los pacientes de más edad presentan tumores más grandes, indiferenciados y con mayor tasa de progresión hacia infiltrantes. Además aparecen como factores significativos independientes en el estudio multivariante: la edad, el estadio patológico y el grado tumoral. Conclusiones: En nuestra experiencia, los pacientes de edad mayor de 70 años presentan neoplasias de características clínicas similares, aunque patológicamente más agresivas, con mayor porcentaje de progresión y peor supervivencia

Introduction: Owing to the different results from the series that evaluate the behavior of the bladder cancer according to the age at the moment of the diagnosis, our objective is based on valuing the characteristics and behaviour according to age of appearance. Methods: A retrospective study of bladder cancer diagnosed in our area during decade 1993-2003, distributed in 3 intervals of age and some characteristics and behaviour are valued. Results: Elderly patients present greater tumors, non differentiated and with greater rate of progression to infiltrated. Moreover the age, the pathological stage and the tumorlike degree appear as independent significant factors in the multivariant study. Conclusions: In our experience, the patients greater than 70 years present neoplasms of similar clinical characteristics, although pathologically more aggressive, with greater percentage of progression and worse survival

[Steroid and xenobiotic receptor (SXR), multidrug resistance gene (MDR1) and GSTs, SULTs and CYP polymorphism expression in invasive bladder cancer, analysis of their expression and correlation with other prognostic factors]. / Expresion del receptor de esteroides y xenobioticos (SXR) y del gen de multirresistencia drogas (MDR1) y de los polimorfismos de las enzimas Gsts, SULTs y CYP en tumores vesicales profundos, analisis de su expresion y correlación con otros factores pronósticos.

INTRODUCTION: Steroid and Xenobiotic Receptor (SXR) has demonstrated its activation by numerous drugs, including cytochrome P450 potent inducers like rifampicina or cotrimazol. The role of SXR is well known, and lies regulating in a positive manner cytochrome P450 3A4 (CYP3A4) transcription and the multidrug resistance gene (MDR1), it's considered a key in the xenobiotic detoxification mechanism, being involved in all phases of the detoxification process. Enzymes involved in Policyclic Aromatic hidrocarbures (PAH) metabolism and degradation are polymorphic in humans, including glutation S-transferases (GSTs), N-acetiltransferases (NATs), sulfotransferases (SULTs)1A1 and cytochrome p450 (CYP)1B1. OBJECTIVES: The objectives we've planned are: 1. Analyze the expression of the transcription factor SXR and MDR1 in bladder by means of RT-PCR real time, both in normal bladder and in tumoral bladder. 2. Analyze the relation between clinical and pathological factors with the expression of SXR and MDR1. 3. Analyze the expression of the polymorphims CYP1B1, GSTM1 GSTT1 and SULT1A1 and their correlation with different clinic-pathological and molecular factors. MATERIAL AND METHODS: In a prospective way the size of the sample was estimated. In 67 patients from two institutions (Hospital Universitario Miguel Servet (49 HUMS) and Clinica Universitaria de Navarra (18 CUN)), diagnosed of invasive bladder cancer and treated by means of radical cystectomy, were determined the expression of both SXR and MDR1 by means of real time PCR, as well as the polymorphisms CYP1B1, GSTM1 GSTT1 y SULT1A1 by means of RFLP (Restriction fragment length polymorphism). Correlations with other prognostic factors by contingency tables were performed. RESULTS: Average follow up was 23.7 months with a median of 28.26 months. Of the 67 patients studied, 31 patients (46.3) presented disease progression, in form of local recurrence or in distant metastasis or both. With a average time to progression of 12.4 months and a median of 10 months, with a range of 1.1 month to 31.9 month. 36 patients (53.7%) did not have any evidence of disease progression during follow up. The Steroid and Xenobiotic Receptor as well as the Multidrug Resistance Gene (MDR1) are expressed in both normal bladder (0.94DeltaCt y 0.94DeltaCt) and tumoral bladder in the cystectomy specimen (1.09 DeltaCt y 0.45 DeltaCt). We've analyzed their expression in a quantitative manner and in a qualitative manner. The expression of SXR correlates with the presence of ca. in situ (p=0.024), vasculo-lymphatic invasion (p=0.05) mean while MDR1 correlates with presence of vasculo-lymphatic invasion (p=0.05) Both factors are correlate between each others (p=0.011). Polymorphisms: CYP1B1, GSTM1, GSTT1 and SULT1A1, are expressed in these patients but their expression doesn't correlates with any prognostic factor CONCLUSIONS: Both SXR and MDR1 are expressed in normal bladder as well as in tumoral bladder. And their expression correlates with different prognostic factors with influence in the survival described in the literature.

[Stage pT0 bladder tumors after radical cystectomy: a review of our series]. / Tumores de vejiga pT0 tras cistectomía radical: análisis de nuestra serie.

OBJECTIVES: To evaluate the data of progression and survival in 43 patients who underwent cystectomy with stage pT0 according to classification TNM-2002. MATERIALS AND METHODS: between 1988 and 2003 in our center had realized 420 cystectomies, 43 patients (10.2%) had not tumor in the cystectomy specimen. RESULTS: In these 43 cases the initial clinical stage (in the transuretral resection of bladder) was T1 in 10 cases (23,3 %), T2 in 31 cases (72%) and T3 in 2 cases. As far as the degree 24 patients presented G2 (55.8%) and 19 (44.2%) were G3. Median time from the transuretral resection to the cistectomy was of 44 days at a median follow-up of 89.3 months. Progression-free survival in the 43 patients was of 180,6 months, but during the follow-up it appeared progression in 7 patients, with disease free survival at 36 months (3-126), since the date of the cistectomia. During the follow up, 5 patients died. When we analyzed the cancer-specific survival according to tumor stage, for the T2 with an average cancer-specific survival is of 180 months, decreasing to 35 months considerably for T3. Similar it happens with the degree of differentiation, significantly diminishing as it advances the degree, with an average of cancer-specific survival for the G3 at 122.6 months. In the same way it happens with pathological positive lymph nodes in the radical cistectomy, with a cancer-specific survival of 188 months when it is N0 and of 54 months if the adenopathy was positive (N+). CONCLUSION: In our experiencie urothelial carcinoma pT0 present a prolonged free period of disease (medium of 180 months). The associated factors of risk to a smaller free period of disease are high degree of differentiation (G3, 116 months), the infiltration of deep layers in the transuretral resection (T3, 32 months) and the ganglionary affectation (pN+ 45 months).

Tumores de vejiga pT0 tras cistectomía radical: análisis de nuestra serie / Stage pT= cystectomy: a review of our serie

Objetivos: Estudiar los datos de progresión y supervivencia en los 43 pacientes cistectomizados y catalogados de pT0 según la clasificación TNM-2002. Material y Métodos: Entre 1988 y 2003 se han realizado en nuestro centro 420 cistectomías, en 43 casos(10,2%) no se halló tumor en la pieza anatomopatológica siendo éstos el núcleo de nuestro análisis. Resultados: En estos 43 casos el estadio clínico inicial (en la resección transuretral de tumor vesical previa a la cistectomía) fue T1 en 10 casos (23,3%), T2 en 31 casos (72%) y T3 en 2 casos. En cuanto al grado 24 pacientes presentaron G2 (55,8%) y 19 (44,2%) fueron G3. La mediana entre la de resección transuretral de tumor vesical diagnóstica (RTU de TM vesical) y la cistectomía fue de 44 días y la mediana del seguimiento fue de 89,3 meses. Progresión. La supervivencia libre de progresión en los 43 pacientes fue de 180,6 meses, pero durante el seguimiento apareció progresión en 7 pacientes con una mediana de supervivencia libre de progresión desde la fecha de la cistectomía de 36 meses (3-126). Supervivencia cáncer-específica (SCE). Durante el seguimiento, 5 enfermos fallecieron, cuatro por la enfermedad y el quinto por un cáncer de pulmón. Si analizamos la SCE, según la anatomía patológica de la RTU de tumor vesical previa, para los T2 la media de SCE es de 180 meses, disminuyendo considerablemente para T3 hasta 35 meses. Similar ocurre con el grado de diferenciación tumoral, disminuyendo significativamente a medida que avanza el grado, con una media de SCE para los G3 de122,6 meses. Del mismo modo ocurre con la afectación ganglionar en la pieza de la cistoprostatectomía radical, con una SCE de 188 meses cuando es N0 y de 54 meses si los ganglios son positivos (N+). Conclusiones: En nuestra experiencia los tumores uroteliales pT0 presentan un periodo libre de enfermedad prolongada (mediana de 180 meses). Los factores de riesgo asociados a un menor periodo libre de enfermedad (PLE) son alto grado de diferenciación (G3, 116 meses), la infiltración de capas profundas en la RTU de tumor vesical(T3, 32 meses) y la afectación ganglionar (pN+) 45 meses

Objectives: To evaluate the data of progression and survival in 43 patients who underwent cystectomy with stage pT0 according to classification TNM-2002. Matherials and methods: between 1988 and 2003 in our center had realized 420 cystectomies, 43 patients (10.2%) had not tumor in the cystectomy specimen. Results: In these 43 cases the initial clinical stage (in the transuretral resection of bladder) was T1 in 10 cases (23,3 %), T2 in 31 cases (72%) and T3 in 2 cases. As far as the degree 24 patients presented G2 (55.8%) and 19 (44.2%) were G3. Median time from the transuretral resection to the cistectomy was of 44 days at a median follow-up of 89.3 months. Progressionfree survival in the 43 patients was of 180,6 months, but during the follow-up it appeared progression in 7 patients, with disease free survival at 36 months (3-126) ,since the date of the cistectomía. During the follow up, 5 patients died. When we analyzed the cancer-specific survival according to tumor stage, for the T2 with an average cancer-specific survival is of 180 months, decreasing to 35 months considerably for T3. Similar it happens with the degree of differentiation, significantly diminishing as it advances the degree, with an average of cancer-specific survival for the G3 at 122.6 months. In the same way it happens with pathological positive lymph nodes in the radical cistectomy , with a cancer- specific survival of 188 months when it is N0 and of 54 months if the adenopathy was positive (N+). Conclusion: In our experiencie urothelial carcinoma pT0 present a prolonged free period of disease (medium of 180 months). The associated factors of risk to a smaller free period of disease are high degree of differentiation (G3, 116 months), the infiltration of deep layers in the transuretral resection(T3, 32 months) and the ganglionary affectation (pN+ 45 months)

Carcinoma papilar hallado en injerto renal tras 13 años de correcto funcionamiento / Carcinoma papilar after 13 years of correct function of graft renal

Es conocida la mayor probabilidad de aparición de lesiones malignas en pacientes con trasplante renal debido a su inmunosupresión. Exponemos un caso en el que tras trece años de correcto funcionamiento del trasplante renal se diagnostica de forma casual mediante ecografía de control un tumor sobre el injerto. Mediante punción ecodirigida se evidenció que se trataba de un carcinoma papilar y se realizó trasplantectomía posterior. Planteamos una reflexión acerca de los tumores de novo sobre injerto renal dado el alto número de pacientes con trasplante funcionante durante largos años y la escasa evidencia en la literatura, proponiendo un posible registro de los mismos para valorar su comportamiento y compararlo con los conocidos sobre riñones nativos sin situación de inmunosupresión

It is known the greater probability appearance of malignancy injuries in patients with renal graft due to its inmunosupresión. We expose a case in which after thirteen years of correct operation of the renal transplant a tumor is diagnosed of accidental form by means of ultrasonography of graft´s control. It was demonstrated by percutaneous biopsy that it was a carcinoma to papilar and later transplanctectomy was made. We raised a reflection about the novo tumors on renal graft given to the high number of patients with funcionante transplant during long years and the little evidence in Literature, proposing a possible registry of such valuing its behavior and comparing it with the well-known ones on native kidneys without inmunosupresión situation

[Primitive neuroectodermal tumor. Ewing's sarcoma]. / Tumor neuroectodérmico primitivo renal/sarcoma de Ewing.

Primitive neuroectodermal tumor is an extraordinarily rare primary tumor in the kidney and can be mistaken for a variety of other round cell tumors. It is important to recognize each of these entities, because each carries unique therapeutic and prognostic implications. However, accurate diagnosis of these tumors is hindered by their significant morphologic overlap and complicated by their rarity. These neplasm are highly aggressive that tend to recurence and to metastatize. Standard therapy combining surgery, chemotherapy, radiation and genetic therapy. We report a case of primitive neuroectodermal tumor of the kidney in a 50 year old female patient.

Tumor neuroectodérmico primitivo renal/Sarcoma de Swing / Primitive neuroectodermal tumor. Ewing´s sarcoma

Los tumores neuroectodérmicos primitivos de riñón son neoplasias extremadamente raras, pudiendo ser confundidas con toda la variedad de tumores de células redondas de riñón. Es importante hacer diagnóstico diferencial entre estas entidades por sus implicaciones terapéuticas y pronosticas, aunque no deja de ser difícil debido a su infrecuencia. Estos tumores son extremadamente agresivos, con tendencia a la recurrencia y a la diseminación temprana a distancia. El tratamiento combina cirugía, quimioterapia y radioterapia, apoyándose en la terapia génica. Aportamos un caso de tumor neuroectodérmico primitivo de riñón en una paciente de 50 años (AU)

Primitive neuroectodermal tumor is an extraordinarily rare primary tumor in the kidney and can be mistaken for a variety of other round cell tumors. It is important to recognize each of these entities, because each carries unique therapeutic and prognostic implications. However, accurate diagnosis of these tumors is hindered by their significant morphologic overlap and complicated by their rarity. These neplasm are highly aggressive that tend to recurence and to metastatize. Standard therapy combining surgery, chemotherapy, radiation and genetic therapy. We report a case of primitive neuroectodermal tumor of the kidney in a 50 year old female patient (AU)

[Pseudotumor renal after partial nephrectomy with the use of surgical gelatin sponge]. / Pseudotumor renal tras el uso de materiales hemostáticos en la nefrectomía parcial.

After renal parenchymal sparing surgery, with the use of surgical gelatin sponge, residual defects may persist on imaging studies at the sites of resection. These "pseudotumors" may lead to confusion as to whether a lesion was removed or has recurred. These lesions usually resolve within a year. We report a case of pseudotumor renal parenchymal sparing surgery in a 69 year old man, with resolution of the lesion 8 months after surgery.

Pseudotumor renal tras el uso de materiales hemostáticos en la nefrectomía parcial / Pseudotumor renal after partial nephrectomy with the use of surgical gelatin sponge

Después de una cirugía renal, en la que se usa materiales hemostáticos absorbibles, defectos residuales pueden persistir en los estudios radiológicos en los márgenes de la resección. Estos “pseudotumores” pueden ser confundidos con enfermedad recurrente o residual. Presentamos un caso de pseudotumor renal tras nefrectomía parcial en un varón de 69 años, en el que se decidió actitud expectante, con resolución de la lesión a los 8 meses de la cirugía

After renal parenchymal sparing surgery, with the use of surgical gelatin sponge, residual defects may persist on imaging studies at the sites of resection. These “pseudotumors” may lead to confusion as to whether a lesion was removed or has recurred. These lesions usually resolve within a year. We report a case of pseudotumor renal parenchymal sparing surgery in a 69 year old man, with resolution of the lesion 8 months after surgery

Carcinoma transicional primario puro de próstata / Pure primary prostate transitional cell carcinoma: A review of our serie

El carcinoma transicional primario de próstata es un tumor raro que ocupa alrededor del 1% de los tumores de próstata. Presentamos seis casos diagnosticados en nuestro hospital hasta finales del año 2002. En todos ellos se descartó el origen vesical de la neoplasia. Nuestro objetivo es estudiar los datos de progresión y supervivencia en los carcinomas primarios puros (sin componente de adenocarcinoma) tratados en nuestro centro en los últimos años. En nuestra experiencia se trata de una neoplasia de pronóstico ominoso con una mediana de supervivencia de 4,6 meses. Con tendencia precoz a metastatizar a distancia. Por tanto, sugerimos la realización de cirugía radical prostática (sin cistectomía) en aquellos casos en los cuales no se evidencia enfermedad en la vejiga (AU)

Primary prostate transitional cell carcinoma is a very uncommon tumor, that represents about 1% of all prostate tumours. In our institution, only six patients have been diagnosed with pure transitional cell prostate carcinoma until 2002. Bladder origin of the neplasic was ruled out in all cases. We report a study about the progression and survival of prostate transitional cell carcinoma. These prostatic tumours carry a poor prognostic (median survival is 4.6 months) with a strong tendency to metastatic spread. Therefore, we suggest a radical prostatectomy (without cystectomy) when it rules out bladder origin tumour (AU)

Supresión Andrógena En Cáncer de Próstata ¿Tratamiento Paliativo? / Androgenic suppression in prostate cancer. A palliative treatment

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[Pelvic recurrence of urothelial tumor, after radical cysto-prostatectomy with orthotopic neo-bladder]. / Recidiva pélvica de tumor urotelial, tras cistoprostatectomía radical con neovejiga ortotópica.

We present a case of an urothelial tumor pelvic recurrence, five months after radical cystoprostatectomy. No fat infiltration was demonstrated in the pathological study of the transurethral resection pieces. The treatment was a radical cystoprostatectomy with an ileal ortothopic Hautmann type neo-bladder. The pathological study of the surgical piece demonstrated fat infiltration in some points but urethra and lymphatic nodes free.