Herniación asintomática de uréter izquierdo en conducto inguinal durante maniobra de valsalva en paciente con doble sistema pielo-ureteral izquierdo completo / Asymptomatic left ureter inguinal hernia during valsalva maneuver in a patient with complete left pyelo ureteral system duplication

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Ectopia renal cruzada fusionada con reflujo vesicoureteral / Crossed fused renal extopia with massive vesicoureteral reflux

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Late recurrence from a renal cell carcinoma: solitary right maxilar mass 17 years after surgery.

OBJECTIVES: To report a new case of late renal cell carcinoma recurrence. METHODS: Renal cell carcinoma represents approximately 3% of all adult malignancies. The most frequent metastatic sites are lung (76%), regional lymph nodes (66%), bone (42%), and liver (41%), and it is the third most common infraclavicular neoplasm to metastasize to head and neck. RESULTS: 73 year-old man with a 1 week history of recurrent epistaxis. He underwent left nephrectomy 17 years before due to a renal mass of 8.5 cm in the upper pole of the left kidney. The histological diagnosis of the referred mass was clear cell carcinoma. No metastatic lesion was found at that time (Stage I, pT2N0M0). CT scan showed a mass in the right nasal cavity, invading the right ethmoidal sinus and the right orbit. Examination under general anaesthesia and biopsy was performed revealing metastasis of a renal cell carcinoma. CONCLUSIONS: The natural history of renal cell carcinoma is highly variable, metastases may present decades after the removal of the primary disease, however, only 1% of patients with renal cell carcinoma have metastases confined only to the head and neck, and solitary cervical metastatic mass is rare. Moreover, renal cell carcinoma should be considered in the differential diagnosis of any growing lesion in the head and neck.

Recidiva tardía de un carcinoma de células renales. Metástasis maxilar derecha 17 años después de la primera cirugía / Late recurrence from a renal cell carcinoma: Solitary right maxilar mass 17 years after surgery

OBJETIVOS: Presentar un nuevo caso de recidiva tardía de un carcinoma de células renales.MÉTODOS: Los carcinomas renales suponen el 3% de todos los tumores en el adulto. Los lugares más frecuentes de afectación metastático son el pulmón (76%), ganglios linfáticos regionales (66%), hueso (42%) e hígado (41%), y además, es la tercera neoplasia infraclavicular en frecuencia en metastatizar en cabeza y cuello RESULTADOS: Varón de 73 años que consulta por episodio de epistaxis de 1 semana de evolución. El paciente había sido sometido a una nefrectomía izquierda por una masa de 8,5 cm en polo superior renal 17 años antes. El informe anatomo patológico fue de carcinoma renal de células claras. No se evidenciaron metástasis en los estudios de extensión previos a la cirugía (Estadio I, pT2N0M0). En el nuevo ingreso se realizó un escaner que mostró una masa en la cavidad nasal derecha que invadía en el seno etmoidal y la órbita derecha. Se llevó a cabo una exploración bajo anestesia con toma de biopsia confirmando la histología de carcinoma renal de células claras.CONCLUSIONES: La historia natural del cáncer renal es muy variable, pudiendo aparecer metástasis décadas después de la nefrectomía inicial, si bien sólo el 1% de estos pacientes presentan metástasis confinadas solamente a la cabeza y cuello. El carcinoma de células renales debe ser considerado en el diagnóstico diferencial de cualquier masa en cabeza y cuello(AU)

OBJECTIVES: To report a new case of late renal cell carcinoma recurrence.METHODS: Renal cell carcinoma represents approximately 3% of all adult malignancies. The most frequent metastatic sites are lung (76%), regional lymph nodes (66%), bone (42%), and liver (41%), and it is the third most common infraclavicular neoplasm to metastasize to head and neck.RESULTS: 73 year-old man with a 1 week history of recurrent epistaxis. He underwent left nephrectomy 17 years before due to a renal mass of 8.5 cm in the upper pole of the left kidney. The histological diagnosis of the referred mass was clear cell carcinoma. No metastatic lesion was found at that time (Stage I, pT2N0M0). CT scan showed a mass in the right nasal cavity, invading the right ethmoidal sinus and the right orbit. Examination under general anaesthesia and biopsy was performed revealing metastasis of a renal cell carcinoma.CONCLUSIONS: The natural history of renal cell carcinoma is highly variable, metastases may present decades after the removal of the primary disease, however, only 1% of patients with renal cell carcinoma have metastases confined only to the head and neck, and solitary cervical metastatic mass is rare. Moreover, renal cell carcinoma should be considered in the differential diagnosis of any growing lesion in the head and neck(AU)

[Significance of anemia as an independent prognostic factor in patients with renal cell carcinoma]. / Anemia como factor pronóstico independiente en pacientes con carcinoma renal.

BACKGROUND AND OBJECTIVE: The aim of this study was to analyze the significance of anemia as well as other prognostic factors influencing survival in patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: A retrospective review of data of 316 patients who underwent surgery between 1970 and 2003 was performed. Most important known prognostic factors of RCC were investigated. RESULTS: Most of patients had T1b-T2, low nuclear grade and single tumours. In 8.2% and 9% of cases, lymph node and metastatic dissemination were detected at the time of diagnosis, respectively. At the beginning, most frequent symptoms were hematuria and pain, with anemia (Hb >10g/dl) in 69 patients. After a median follow-up of 50 months, 24.1% of patients had a recurrence. From these, more than 50% developed recurrence within one year after nephrectomy. Advanced tumours (T3-4) consisted of high nuclear grade (III-IV) tumours, larger size tumours, with necrosis and vascular infiltration in surgical specimen, as well as lymph node and metastatic dissemination. In multivariate analysis, anemia, time to recurrence, type of treatment for recurrence as well as lymph node dissemination were independent factors of cancer specific survival. CONCLUSION: Anemia seems to be a marker of recurrence and progression in patients with renal cell carcinoma undergoing nephrectomy. From our point of view, anemia could be considered a significantly high mortality rate for renal cancer in these patients.

Anemia como factor pronóstico independiente en pacientes con carcinoma renal / Significance of anemia as an independent prognostic factor in patients with renal cell carcinoma

Fundamento y objetivo: Valorar el significado pronóstico de la anemia para el carcinoma de células renales (CCR), así como otros factores implicados en la supervivencia. Pacientes y método: Se realizó un análisis retrospectivo de los datos de 316 pacientes con carcinoma renal intervenidos entre los años 1970 y 2003. Se investigaron las principales características implicadas en el pronóstico de pacientes con CCR. Resultados: La mayoría de los tumores presentaron estadios bajos T1b-T2, con grados nucleares bajos (I–II) y un tumor único. En un 8,2% se encontró afectación ganglionar en el momento del diagnóstico y en casi un 9% existían metástasis a distancia. La clínica más frecuente al inicio fue hematuria o dolor, y la anemia (hemoglobina<10g/dl) estuvo presente en 69 casos Resultados: Con una mediana de seguimiento de 50 meses, recidivó un 24,1% de casos, de los que más del 50% ocurrió en el primer año tras la intervención. Los tumores avanzados (T3-4) tendieron a presentar un grado nuclear mayor (III–IV), más tamaño, necrosis, afectación vascular y ganglionar, asociándose más frecuentemente a metástasis a distancia. Los factores que influyeron de forma independiente en la mortalidad específica por cáncer fueron la presencia de adenopatías metastásicas, el tiempo libre de enfermedad en los casos con recidiva, así como el tratamiento de esa recidiva y la presencia de anemia. Conclusión: La existencia de anemia en pacientes intervenidos por carcinoma renal puede ser un marcador de recidiva y progresión de la enfermedad que implica, finalmente, un mayor riesgo de mortalidad por este tumor (AU)

Background and Objective: The aim of this study was to analyze the significance of anemia as well as other prognostic factors influencing survival in patients with renal cell carcinoma (RCC). Patients and methods: A retrospective review of data of 316 patients who underwent surgery between 1970 and 2003 was performed. Most important known prognostic factors of RCC were investigated. Results: Most of patients had T1b-T2, low nuclear grade and single tumours. In 8.2% and 9% of cases, lymph node and metastatic dissemination were detected at the time of diagnosis, respectively. At the beginning, most frequent symptoms were hematuria and pain, with anemia (Hb >10g/dl) in 69 patients. Results: After a median follow-up of 50 months, 24.1% of patients had a recurrence. From these, more than 50% developed recurrence within one year after nephrectomy. Advanced tumours (T3-4) consisted of high nuclear grade (III–IV) tumours, larger size tumours, with necrosis and vascular infiltration in surgical specimen, as well as lymph node and metastatic dissemination. In multivariate analysis, anemia, time to recurrence, type of treatment for recurrence as well as lymph node dissemination were independent factors of cancer specific survival. Conclusion: Anemia seems to be a marker of recurrence and progression in patients with renal cell carcinoma undergoing nephrectomy. From our point of view, anemia could be considered a significantly high mortality rate for renal cancer in these patients (AU)

Metástasis subcutánea de cáncer de próstata / Subcutaneous metastasis of prostate cancer

OBJETIVOS: La tendencia a la diseminación del cáncer de próstata es sobre todo a los ganglios linfáticos regionales y hueso, y en una menor proporción a pulmón, hígado y cerebro. El hallazgo de metástasis en otras localizaciones es un hecho excepcional.El objetivo de este trabajo es revisar la frecuencia y características clínicas de las metástasis de adenocarcinoma de próstata en el tejido celular subcutáneo.MÉTODOS: Presentamos el caso de un varón de 71 años que se diagnosticó de un adenocarcinoma de próstata. Se realiza prostatectomía radical y colocación de esfínter artificial por incontinencia urinaria de esfuerzo.RESULTADOS: Durante el seguimiento evoluciona con progresion bioquímica, recidiva local y metástasis óseas, es diagnosticado de metástasis en tejido subcutáneo perirreservorio de esfínter artificial.CONCLUSIONES: El cáncer de próstata es una enfermedad muy prevalerte en nuestro medio, en la cuál el hallazgo clínico de metástasis en órganos distintos al hueso o ganglios linfáticos regionales, se sigue de un corto periodo de supervivencia. El diagnóstico de metástasis en el tejido subcutáneo es un hecho que tal vez estar infradiagnosticado debido su curso clínico indolente y que podría además no elevar las cifras de PSA, en cualquier caso es un dato de mal pronóstico(AU)

OBJECTIVES: Prostate cancer tends to spread to regional lymph nodes and bone, and, to a lesser degree, to lung, liver, and brain. Metastases in other locations are exceptional.To review the frequency and clinical characteristics of metastasis to subcutaneous cellular tissue in adenocarcinoma of the prostate.METHODS: The case of a 71-year-old man diagnosed of adenocarcinoma of the prostate is reported. The patient underwent radical prostatectomy and artificial sphincter for stress urinary incontinence.RESULTS: During follow-up the patient showed biochemical progression, local recurrence, and bone metastasis. The disease metastasized in the subcutaneous tissue around the reservoir of the artificial sphincter.CONCLUSIONS: Prostate cancer is highly prevalent in our part of the world. The clinical finding of metastasis in organs other than bone or regional lymph nodes is accompanied by a short survival. Metastases in subcutaneous tissue may be underdiagnosed due to its indolent clinical course and possible absence of PSA elevation. In any case, subcutaneous metastases have an unfavorable prognosis(AU)

[Nonspecific sexual cord testicular tumor. Case report]. / Tumor testicular de los cordones sexuales no específico. Presentación de un caso.

OBJECTIVE: We report one case of gonadal stromal testicular tumor and perform a bibliographic review. METHODS/RESULTS: We present the case of a 42 year-old male patient consulting for a painless right testicular mass. Orchiectomy was performed and the patient underwent follow-up. CONCLUSIONS: Nonspecific sexual cord tumors are extremely rare, with slow growing and benign behaviour, presenting positive staining for various markers.

Tumor testicular de los cordones sexuales no específico. Presentación de un caso / Nonspecific sexual cord testicular tumor. Case report

Objetivos: Presentamos el caso de un tumor testicular del estroma gonadal y revisamos la literatura al respecto. Métodos/Resultados: Presentamos el caso de un varón de 42 años que consulta por bultoma indoloro en testículo derecho, practicándose orquiectomía y seguimiento. Conclusiones: Los tumores de los cordones sexuales no específicos son una entidad extremadamente rara, con un crecimiento lento y comportamiento benigno, que presentan positividad para distintos marcadores (AU)

Objective: We report one case of gonadal stromal testicular tumor and perform a bibliographic review. Methods/Results: We present the case of a 42-year-old male patient consulting for a painless right testicular mass. Orchiectomy was performed and the patient underwent follow-up. Conclusions: Nonspecific sexual cord tumors are extremely rare, with slow growing and benign behaviour, presenting positive staining for various markers (AU)

Ectopía renal cruzada fusionada (ectopía inferior) / Fused crossed renal etcopia (inferior ectopia)

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