Papel del urólogo en el tratamiento del cáncer renal / Role of the urologist in the treatment of renal cancer

No disponible

Metástasis testicular metacrónica secundaria a adenocarcinoma renal de células claras / Metachronic testicular metastasis secondary to clear cell renal adenocarcinoma

Objetivo: Presentar un caso de metástasis inusual en testículo de origen renal. Método: Paciente de 57 años afecto y en tratamiento por un cáncer renal derecho diseminado que durante su evolución con terapia médica aparecieron metástasis óseas y un nódulo doloroso en polo superior testicular derecho, que obligó a cirugía, con resultado de metástasis de adenocarcinoma de células claras. Resultado: A los 6 meses el paciente sigue en tratamiento con sorafenib oral sin que se hayan manifestado más implantes metastáticos. Conclusiones: Los tumores secundarios metástasicos en testes suponen menos del 1% del total de tumores testiculares. En pacientes en la 5ª y 6ª década, sobre todo afectos de otras neoplasias, las masas testiculares acostumbran a ser implantes metastáticos. El origen más frecuente es el prostático (AU)

Objective: To report one case of unusual testicular metastasis from a renal origin. Methods: 57-year-old patient with disseminated right renal cancer under treatment who presented bone metastasis and a painful nodule in the upper pole of the right testicle during his follow-up with medical therapy, making surgery necessary. The pathology result was clear cell adenocarcinoma. Results: Six months later the patient continues under oral Sorafenib without evidence of new metastatic implants. Conclusions: Testicular secondary metastatic tumors account for less than 1% of old testicular tumors. In patients in the fifth and sixth decades, mainly if they are affected by other neoplasias, testicular masses use to be metastatic implants. The most frequent origin is prostate (AU)

Angiomiolipoma epiteloide renal / Epithelioid renal angiomyolipoma

Objetivo: Poner de manifiesto la existencia de una variedad de angiomiolipoma, denominada epitelioide, con propiedades diferentes tanto histológicas como clínicas. Método: Se presenta el caso de una mujer de 17 años, afecta de enfermedad de Bourneville, a la que en un control tomográfico renal se descubre la existencia de una masa sólida sugestiva de carcinoma, adyacente a otras de menor tamaño identificadas como angiomiolipomas. Resultados: Tras realizar varias tumorectomías, la sospechosa de carcinoma, de 4 cm de tamaño se diagnostica de angiomiolipoma epitelioide, con corroboración inmunohistoquímica mediante positividad para HMB45, y negatividad a vimentina y queratina. Conclusiones: A pesar de la posibilidad de coexistencia de adenocarcinoma y angiomiolipomas, no hay que descartar la existencia de la variedad epitelioide, sobre todo en pacientes con facomatosis. Los criterios quirúrgicos serán los mismos que para el resto de masas renales. Sin embargo, los criterios de seguimiento deberán ser más estrictos dada la posible evolución tórpida en cuanto a diseminación de esta infrecuente variedad de angiomilipoma (AU)

Objective: To issue the existence of a variety of angiomyolipoma, named epithelioid, with different histological and clinic properties. Methods: We report the case of a 17-year-old female, with Bourneville’s disease, who was discovered to have a solid renal mass suggestive of carcinoma in a control CT scan, adjacent to other smaller masses identified as angiomyolipomas. Results: After several tumorectomies, the suspicious mass, 4 cm in size, was diagnosed as epithelioid angiomyolipoma, with immunohistochemical confirmation of capacity for HMB45, and negative vimentin and keratin. Conclusions: Despite the possibility of coexistence of adenocarcinoma and angiomyolipoma, the existence of an epithelioid variety cannot be discarded, mainly in patients with phakomatosis. The indications for surgery are the same than for the rest of renal masses. Nevertheless, follow-up criteria must be stricter due to the possibility of torpid outcome in terms of dissemination of this infrequent variety of angiomyolipoma (AU)

Fusión esplenogonadal / Splenogonadal fusion

Objetivo: Presentar un caso de fusión esplenogonadal discontinua, entidad de escasa referencia, de interés clínico, sin repercusiones importantes en la mayoría de los casos. Métodos: Varón de 23 años diagnosticado de masa paratesticular derecha, con marcadores tumorales germinales negativos. Ecográficamente homogénea y normoecógena respecto a parénquima testicular adyacente. Tras la exploración quirúrgica se realizó exéresis de la citada masa, informada anatomopatológicamente de fusión esplenogonadal, con tejido esplénico dentro de la normalidad. Resultado: Quizás más frecuentes durante la práctica de urología y cirugía infantil, la fusión esplenogonadal presenta dos formas diferenciadas: la continua en la que entre bazo y la gónada existe un cordón fibroso o nodular situado a nivel retro o intraperitoneal, y la discontinua en la que no hay comunicación topográfica entre bazo y tejido esplénico ectópico adyacente al teste. Conclusiones: Si bien excepcionales, los restos esplénicos fusionados a teste, epidídimo o vaso deferente, pueden representar una duda diagnóstica frente al tumor testicular y masas paratesticulares (AU)

Objective: To report one case of discontinuous splenogonadal fusion, an rarely referred entity, with clinical interest, without important repercussions in most cases. Methods: 23-year-old male with the diagnosis of right paratesticular mass, with negative markers for germ cell tumors. On ultrasound the mass was homogeneous and isoechoic in comparison with the adjacent testicular parenchyma. On surgical exploration, the mass was excised, with the pathologic result of splenogonadal fusion, with normal splenic tissue. Results: Being maybe more frequent in pediatric surgery and urology practices, splenogonadal fusion presents two differentiated forms: continuous with a fibrous or nodular cord from the spleen to the gonad, retroperitoneal or intraperitoneal; and discontinuous in which there is no topographic communication between spleen and ectopic splenic tissue adjacent to the testicle. CONCLUSIONS: Although they are exceptional, splenic remainders fused to the testicle, epididymis or vas deferens may present the differential diagnosis with testicular and paratesticular masses (AU)

[Scrotal liposarcoma]. / Liposarcoma escrotal.

OBJECTIVE: To describe an additional case of scrotal liposarcoma and its treatment, which was distinct from conventional treatment. METHODS: The literature on paratesticular masses is reviewed with special reference to the liposarcomas. An additional case of liposarcoma is described which was treated by tumor excision without involvement of the testis. The diagnosis, classification and treatment of this condition are discussed. RESULTS: Liposarcoma is a very uncommon tumor and its diagnosis is based on the anatomopathological findings. Treatment is by orchidectomy with high ligation of the spermatic cord. However, the case described herein was treated only by resection of the tumor. Radiotherapy may be indicated in some cases. Chemotherapy does not appear to be useful in this type of tumor. CONCLUSION: In some cases of scrotal liposarcoma, the tumor can be resected without performing orchidectomy.

[Pelvic lipomatosis: contribution of a new case to the literature]. / Lipomatosis pelviana: aportación de un nuevo caso a la literatura.

OBJECTIVE: To describe an additional case of pelvic lipomatosis, a rare condition that can be encountered by the urologist. METHODS/RESULTS: A 66-year-old patient consulted for irritative voiding syndrome and fever. Patient evaluation by IVP and CT demonstrated pelvic lipomatosis. CONCLUSIONS: Pelvic lipomatosis is a disease with variable clinical and radiological features. Careful follow-up is warranted for prevention and treatment of possible complications.

A propósito del trabajo "metástasis intracraneales en cáncer de próstata" / A propos of the work "Intracranial metastasis of the prostate"

No disponible

[Relation between renal transplantation and work situation]. / Relación entre trasplante renal y situación laboral.

OBJECTIVE: The present study analyzed occupational rehabilitation following renal transplantation and its impact on social costs. METHODS/RESULTS: A survey was conducted on 493 patients who had undergone renal transplantation during 1979 to 1995. The results show that 27.76% were working after kidney transplantation versus 27.52% during dialysis. Retirement was the most common explanation given for not working (29.4%) when the percentage of those over age 65 accounted for 8%. CONCLUSION: Analysis of the occupational status in relation with sex, age, level of education, profession and type of dialysis disclosed that women aged 25-34 years, with a high level of education, who describe themselves as entrepreneurs and have had peritoneal dialysis, have a higher likelihood of working after transplantation.

[Vasitis nodosa]. / Vasitis nodosa.

OBJECTIVE: To describe a case of vasitis nodosum causing spontaneous recanalization of the vas deferens. METHODS: Herein we describe a patient who had undergone vasectomy 9 years earlier. A nodule in the vas deferens arising from granulomatous reaction had progressed to vasitis nodosum, causing spontaneous recanalization of the vas deferens. RESULTS: Vasitis nodosum may be more frequent than it is considered to be although clinical problems rarely arise. CONCLUSION: Confusion may arise in distinguishing the histological features of vasitis nodosum from those of adenocarcinomatous neoplasia. Although rarely, its growth may cause recanalization of the vas deferens in vasectomized patients.

[Extragonadal germinal tumor]. / Tumor germinal extragonadal.

OBJECTIVE: Extragondal germ cell tumors are rare and have a high affinity for the midline structures. Herein we describe a young, male patient with a retroperitoneal primary tumor. METHODS/RESULTS: The unorthodox form of presentation of germ cell tumors corroborates their embryologic gonadal origin which is distant from the site of presentation. CONCLUSION: The diagnostic algorithm, chemotherapeutic and surgical treatment guidelines utilized in the management of primary gonadal germ cell tumors with retroperitoneal involvement remain applicable in this rare form of presentation.

[Paratesticular adenomatoid tumor]. / Tumor adenomatoide paratesticular.

OBJECTIVE: To report a case of paratesticular tumor involving the right testis. METHODS/RESULTS: A middle-aged male with a small paratesticular tumor involving the right testis is described. Treatment was by transscrotal surgical excision. The histological analysis of the surgical specimen disclosed a mesothelial tumor and no evidence of malignancy. CONCLUSION: Although the preoperative diagnosis of adenomatoid tumor is relatively simple when the epididymis is involved, localization in the testis is relatively difficult to determine. Surgical exploration of all intrascrotal and intratesticular tumors are advocated due to the risk of malignancy.

[Sexual changes in men with urological disorders]. / Alteraciones sexuales en varones con trastornos urológicos.

OBJECTIVE: To evaluate the changes in sexual function due to urological pathologies and their treatment in the male. The present study analyzed erection, ejaculation, frequency of sexual intercourse and orgasm. METHODS: A questionnaire comprised of 30 items were sent out to 1016 males over 18 years of age with urological disease that had been treated from 1990 to 1991. Data processing was carried out using the Statgraphics and Statistica programs. The x2 and Wilcoxon Z tests were utilized for statistical analysis. RESULTS: All of the parameters studied were found to be impaired in a high number of patients in relation to age, pathology and treatment. Benign prostatic hyperplasia and its treatment caused the most impairment. CONCLUSIONS: Erection, ejaculation, frequency of sexual intercourse and orgasm decreased significantly after a urological condition. In our view, patient preoperative data and analysis of the foregoing parameters are warranted.

[Pararenal angiomyolipoma]. / Angiomiolipoma pararrenal.

OBJECTIVES: To review the more relevant clinical aspects of extrarenal angiomyolipoma, an uncommon disease entity. METHODS: The patient was a middle-aged female in whom an irregular right extrarenal mass had been detected. The pathological analysis disclosed a hamartoma. RESULTS: Complete resection of this lesion achieved cure. METHODS: Angiomyolipoma is a benign tumor that generally involves one or both kidneys. Extrarenal angiomyolipoma is extremely uncommon and may warrant the use of diagnostic tools distinct from the widespread algorithm and may require aggressive maneuvers to make the correct diagnosis.

[Vascular testicular tumors]. / Tumores vasculares testiculares.

OBJECTIVES: The present study reviews vascular testicular tumors, a very rare pathology. To our knowledge, only 17 cases have been reported since 1921. METHODS/RESULTS: We describe a case of a 16-year-old male who consulted for a mass of sudden onset. Pathological examination disclosed a testicular angioma. CONCLUSIONS: Despite the advancements of the imaging techniques, there are no signs that indicate the nature of vascular testicular neoplasms. The good prognosis of these tumors underscores the importance of the anatomopathological differential diagnosis.

[Intestinal obstruction caused by transitional carcinoma]. / La obstrucción intestinal por carcinoma transicional.

OBJECTIVES: To draw attention to the possibility that distant intestinal metastasis can arise from transitional urothelial carcinoma located in the bladder. METHODS: Two female patients developed distant metastasis during treatment of the tumor by transurethral resection of the bladder. RESULTS: Following complicated transurethral resection with perforation of the peritoneal cavity, the patients developed intestinal obstruction from metastatic transitional cell carcinoma. CONCLUSIONS: Direct or distant seeding of tumor cells on previously undamaged peritoneal serosa produced with the resectoscope may not be exceedingly unlikely.

[Intraprostatic blue nevus]. / El nevus azul intraprostático.

OBJECTIVES: The present article describes an additional case of blue nevus of the prostate, a rare benign lesion which must be distinguished from the more aggressive lesions. METHODS/RESULTS: This lesion was incidentally discovered in a patient who had a biopsy of the prostate. The microscopic examination disclosed the presence of melanin in the epithelium of the prostate gland. CONCLUSIONS: Extracutaneous blue nevus does not progress to malignancy and must be distinguished from the more aggressive lesions.

[Renal cystic mass: the diagnostic dilemma]. / Masa quística renal: el dilema diagnóstico.

OBJECTIVE: To determine the best diagnostic approach and management of cystic renal mass. METHODS: Four cases are described and the literature reviewed. RESULTS: Of the 4 cases of cystic renal mass, 2 had a previous history of renal trauma. Puncture and aspiration of the cystic content were performed in three cases; cytology was positive for malignancy in one, which was confirmed by the histologic analysis. Two cases underwent nephrectomy although one of the post-traumatic cases had a preoperative diagnosis of pararenal pseudocyst. The literature review showed a significant controversy exists concerning the diagnostic approach and treatment. CONCLUSIONS: We advocate an approach free from tenets, where all the appropriately chosen diagnostic tools may be valid. If doubts persist after diagnostic evaluation, nephrectomy should be performed.