Birdshot- like retinocoroidopatía como comienzo de la enfermedad de Whipple / Birdshot-like retinochoroidopathy as onset of Whipple's disease

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[Cystic tumors in the retrorectal space. Do these two cases have something in common?]. / Tumoraciones quísticas del espacio retrorrectal. ¿Tienen algo en común estos dos casos?

Cystic lesions in the retrorectal or presacral space present a broad differential diagnosis. Rare but typical lesions at this site are those related to embryonic development, which are the most frequent presacral congenital lesions in adults. Amongst these tumors, epidermoid cysts and cystic hamartomas are the most common lesions. Cystic masses, which are asymptomatic in approximately 50% of the cases at diagnosis, may show complications such as infection or malignant degeneration. Initial diagnosis is based on imaging techniques although definite lesion characterization, essential due to their malignancy risk, is given by the pathological analysis of the surgical piece.

Tumoraciones quísticas del espacio retrorrectal. ¿Tienen algo en común estos dos casos? / Cystic tumors in the retrorectal space. Do these two cases have something in common?

Las lesiones del espacio retrorrectal o presacro plantean un amplio diagnóstico diferencial. Una patologíatípica aunque rara de esta localización son las masas quísticas relacionadas con el desarrollo embrionario, que constituyen las lesiones congénitas presacras más frecuentes en el adulto. De éstas, los quistes epidérmicos y los hamartomas quísticos son las más comunes. Asintomáticas hasta en la mitad de los casos al diagnóstico, las masas quísticas pueden presentar complicaciones infecciosas e incluso degeneración maligna. El diagnóstico inicial se basa en las pruebas de imagen, aunque la caracterización definitiva, de gran importancia dado el riesgo de malignización, viene dada por la anatomía patológica de la pieza quirúrgica. Presentamos dos casos clínicos de lesiones quísticas retrorrectales diagnosticadas en nuestro centro (AU)

Cystic lesions in the retrorectal or presacral space present a broad differential diagnosis. Rare but typical lesions at this site are those related to embryonic development, which are the most frequent presacral congenital lesions in adults. Amongst these tumors, epidermoid cysts and cystic hamartomas are the most common lesions. Cystic masses, which are asymptomatic in approximately 50 % of the cases at diagnosis, may show complications such as infection or malignant degeneration. Initial diagnosis is based on imaging techniques although definite lesion characterization, essential due to their malignancy risk, is given by the pathological analysis of the surgical piece (AU)

Leiomioma de escroto: aportación de un caso / Leiomyoma of scrotum: contribution of one case

El leiomioma escrotal es un tumor raro de comportamiento benigno, asintomático, originado en el músculo dartos y cuyo tratamiento de elección es quirúrgico. Presentamos un nuevo caso en un paciente varón de 68 años con una masa escrotal de 10 años de evolución que, tras ser extirpada, el diagnóstico anatomopatológico fue de leiomioma (AU)

Scrotal leiomyoma is a benign rare tumour, asymptomatic, which origin is the dartos muscle and the election treatment is surgical. We report a new case in a 68-year-old patient with a 10 years history of a scrotal tumour and anatomopathological diagnostic post surgery was leiomyoma (AU)

[Scrotal leiomyoma: report of a case]. / Leiomioma de escroto: aportación de un caso.

Scrotal leiomyoma is a benign rare tumour, asymptomatic, which origin is the dartos muscle and the election treatment is surgical. We report a new case in a 68-year-old patients with a 10 years history of a scrotal tumour and anatomopathological diagnostic post surgery was leiomyoma.

[Morphology of severe mycoses. Role of the pathologist in the diagnosis]. / Expresión morfológica de las infecciones fúngicas graves. Participación del patólogo en el diagnóstico.

Mycoses are diseases caused by fungi. To be regarded as pathogenic, a fungus has to be able to complete a number of steps in order to initiate infection. Although culture remains the gold standard to diagnose the causative agent, presumptive identification of these fungi in histologic slides is of great value because invasion is only demonstrated in tissue sections. When culture is not available, histopathologic examination may be the sole source of information about the nature of the infection. To make a diagnosis, the pathologist needs to be familiar with the morphologic appearance of the different types of fungi, and has also to be aware of the limitations in their identification. The purpose of this work is to review the current problems on this subject, specially referring to the most frequent severe mycoses of our environment.

Jejunal stromal tumor with skeinoid fibers or myenteric plexoma: a case report.

Small intestinal stromal tumors with 'skeinoid fibers' are uncommon stromal tumors with an associated controversial histogenesis. Although their microscopic appearance is suggestive of a smooth muscle nature, they lack specific smooth muscle features, as evident by electron microscopy and immunohistochemistry. They also appear to lack features of neurogenic origin because they fall to react with neural/neuroendocrine markers such as S-100 protein, neuron-specific enolase and chromogranin. It is interesting, nonetheless, to note that the ultrastructural examination of these tumors may show structures reminiscent of neural differentiation, such as cytoplasmic projections, containing occasional membrane-bound, dense-core, neurosecretory-type granules, which mimick the long cytoplasmic processes seen in tumors of neural origin. Moreover, the association of these tumors with Von Recklinghausen's neurofibromatosis, as well as the presence of 'skeinoid fibers' in proven neurogenic spindle cell neoplasms such as gastrointestinal autonomic nerve tumors and schwannomas, suggests that these tumors might also be neurogenic in origin and enhances the diagnostic value of 'skeinoid fibers' as a possible ultrastructural marker of neural differentiation. Thus, light microscopic evaluation is clearly insufficient to accurately diagnose these tumors and to determine their histogenesis, electron microscopic and immunohistochemical studies being necessary. In this article the histogenesis of small intestinal stromal tumors with 'skeinoid fibers', regarding a jejunal neoplasm in a 63-year-old patient, is reviewed. The light microscopic, immunohistochemical and ultrastructural features are described and compared with findings usually seen in all those stromal tumors which may raise a differential diagnosis, such as smooth muscle stromal tumors, gastrointestinal autonomic nerve tumors, schwannomas, paragangliomas and fibrosarcomas.

[Screening of cancer of the prostate: study in a Spanish population]. / Screening del cáncer de próstata: estudio en una población española.

OBJECTIVES: A population of Spanish men aged over 49 years were screened for prostate cancer. The detection rate and the clinical features of the tumors found are analyzed. METHODS: The study comprised two phases: Phase I: Subjects were evaluated by digital rectal examination (DRE) and prostate-specific antigen (PSA) was determined. Phase II: Subjects with a positive DRE or PSA > 4 ng/ml were evaluated by transrectal US. If PSA was > 10 ng/ml or DRE or transrectal US were abnormal, a transrectal biopsy was performed; most of these were sextant. PSA density was used as a criterion for biopsy in subjects with PSA 4-10 ng/ml and normal DRE and transrectal US. From June, 1993 to August 1994, 1091 subjects have been evaluated. RESULTS: 1) The mean age was 59.32 years; 379 (34.7%) had low voiding symptoms. 2) 5.07% and 9.07% had abnormal DRE and PSA, respectively; 135 subjects (12.4%) with a questionable DRE and/or PSA were evaluated by transrectal US. 3) Of the 97 biopsies (8.8%) performed, prostate cancer was detected in only 11 (1%); 8.8 biopsies were required to detect one case of prostate cancer. 4) Clinically, 7 tumors (63.6%) were localized and 4 (36.3%) were in the advanced stages. CONCLUSIONS: 1) The participation rate was low (21%). 2) The PSA mean increased with age. Prostate volume was the factor that most influenced PSA changes. 3) PSA detected more tumors (10 cases; 90.9%) than DRE (8 cases; 72.7%). Approximately 27.27% of the lesions were detected by PSA and not by DRE, while 9.09% were detected by DRE alone. 4) The detection rate was low (1.008%); 0.91% for PSA, 0.73% for DRE and 51% (n = 135) for transrectal US. 5) We have detected more tumors in the clinically advanced stages (36.6%) than other series, perhaps because this is the first time this type of study has been performed in this population. In view of the foregoing results, we do not advocate performing these studies routinely. Perhaps in subsequent studies with a longer follow up, a higher detection rate can be achieved for localized tumors that are potentially curable.

[Treatment of ureteral stenoses with the Acucise catheter]. / Tratamiento de las estenosis ureterales con el catéter Acucise.

OBJECTIVES: A new form of minimally invasive treatment of ureteral stricture with the Acucise catheter is described herein. METHODS: The method for catheter use for the ureteral incision using radiological control alone is described. RESULTS: The technique is easy to perform. There were no early postoperative complications in strictures at the juxtavesical or upper lumbar ureter. CONCLUSIONS: The availability of balloon dilatation catheters equipped with an electrocautery device permits incision of the ureteral stricture using radiological control alone, preferably those in the juxtavesical or upper lumbar ureter. Those localized to other levels of the ureter are not free from vascular or visceral lesions.

[Yield of ultrasonography-guided transrectal biopsy in the diagnosis of carcinoma of the prostate]. / Rendimiento de la biopsia transrectal ecodirigida en el diagnóstico del carcinoma de próstata.

OBJECTIVES: The present study analyzes the combination of digital rectal examination (DRE), prostate specific antigen (PSA), transrectal ultrasound (TRUS) and ultrasound-guided transrectal biopsy in the diagnosis of prostate cancer. METHODS: 115 of 224 patients (51.3%) were biopsied due to a suspicious DRE and/or PSA > 4 ng/ml, and/or DPSA > 0.15, and/or the presence of a hypoechoic lesion on TRUS. RESULTS: Adenocarcinoma of the prostate was diagnosed in 28 (24.3%) of these 115 patients. The positive predictive value (PPV) for carcinoma of the prostate was 4.76% if PSA was < 4 ng/ml, 5.12% if PSA was 4.1 to 10 ng/ml, and 48% if PSA was > 10 ng/ml. If DPSA is considered, the PPV is 7.4% if PSA is 4.1 to 10 ng/ml and 51.02% if PSA is > 10 ng/ml. If DRE is suspicious, the PPV is 43.6%, with a sensitivity of 85.7% and a specificity of 63.9%. The PPV for carcinoma of the prostate was 34% for a hypoechoic lesion on TRUS, 50% if DRE is suspicious, 53.5% is PSA is > 10 ng/ml and 65% if DRE is suspicious and PSA > 10 ng/ml. CONCLUSIONS: The detection rate of carcinoma of the prostate is increased when DRE, PSA, TRUS and US-guided transrectal biopsy are used in combination.

[Conservative treatment of muscle-infiltrating bladder tumors with TUR]. / Tratamiento conservador mediante RTU de los tumores vesicales musculoinfiltrantes.

OBJECTIVES: The absence of tumor in up to 10% of cystectomy specimens of patients with invasive bladder cancer justify the search for non aggressive therapies. The present study attempts to establish the safety and curative capacity of TUR alone for patients with superficial muscle-infiltrating bladder cancer. METHODS: Over a period of 18 months, 12 patients with superficial muscle-infiltrating bladder cancer (T2) were diagnosed at our department, TUR was repeated in 9 of the 12 patients. The extension study was negative in all 9 patients. RESULTS: The mean follow up was 12.8 months (range 7-70 months). Local recurrence was found in 4 patients (44.4%) who were submitted to another TUR; 3 were superficial and 1 invasive (with the same muscle involvement as at the initial diagnosis). The tumor-free survival rate was 9.3 months. No patient showed tumor progression. CONCLUSION: The percentage and nature of local recurrence, tumor-free survival and the progression rate (which was not observed during the short follow up period) indicate that TUR is a treatment option that must be taken into account in selected patients with invasive bladder cancer.

[Diagnostic and therapeutic retrograde ureterorenoscopy (URS)]. / Ureterorrenoscopia retrograda (URS) diagnostica y terapeutica.

Presentation of results obtained in 50 procedures of retrograde ureterorenoscopy (URS), and discussion based on the literature and our results, on the current indications for URS with regard to extracorporeal lithofragmentation (ECL) for the treatment of pelvic ureteral lithiasis and the diagnosis and/or treatment of other conditions. Fifty URS were performed in 47 patients between February 1992 and March 1994: 35 were conducted to treat ureteral lithiasis, achieving a 97% success rate and a mean post-surgery hospital stay of 48 hours; and for diagnostic and/or therapeutic reasons. There were no major complications, and a description is made of minors cases. We prefer to use URS in those cases of distal ureteral lithiasis, as compared to ECL, because of its level of efficacy (higher than or equal to ECL), low cost/benefit ratio, low morbidity and shorter hospital stay involved. The paper emphasizes the major diagnostic and therapeutical indications for URS, and finally, it is noted that URS can avoid undertaking other more aggressive urinary by-passes, since it allows to catheterize the ureters where a false intramural route is conducted.

[Ureteral resection of ureteral inflammatory polyp associated with lithiasis]. / Ureteroresección de un pólipo inflamatorio ureteral asociado a litiasis.

We report on a fibroepithelial polyp case with inflammatory characteristics located in the pelvian ureter, and related with an ureteral calculus, which was treated in a conservative way with ureteroscopic resection, after the pincer extraction of the stone. Our team found two fibroepithelial polyp cases in the bibliography reviewed treated with ureteroscopic resection. We consider that the polyp's reactive inflammatory nature is due to the urothelial chronic irritation caused by the calculus.

[Value of preoperative autotransfusion in elective urologic surgery]. / Interés de la autotransfusión preoperatoria en cirugía urológica electiva.

Over a period of 5 months, 50 patients were entered into the preoperative autologous blood donation program of our Service. Two patients were excluded; one had previously had an acute myocardial infarction and the other had epilepsy. The remaining 48 patients, which accounted for one third of our elective surgery procedures, all accepted to enter the program. These patients were not more severely anemic than the other patients not in the program and who underwent the same surgical procedures. No patients required homologous blood transfusion and no complications ascribable to the procedure were observed. Although it is not utilized widely to date, predeposited autologous blood transfusion is a safe and efficient method, with no remarkable morbidity, even in patients aged over 65 years, the age group of one half of our patients. Autologous blood transfusion programs are necessary. The indications, the exclusion criteria for patients at high risk and the objective parameters for evaluating its success must be established.

[Eosinophilic cystitis]. / Cistitis eosinofílica.

We report two cases of eosinophilic cystitis that had been diagnosed anatomo-pathologically after TUR. These patients had a previous history of low grade and stage superficial bladder tumor that had been treated by intravesical interferon after surgery. The literature is reviewed highlighting the etiopathogenic aspects, the possible relationship with immune allergic factors, clinical aspects, diagnosis and treatment.

[Lower gastrointestinal hemorrhage caused by jejunal leiomyoblastoma]. / Hemorragia digestiva baja por leiomioblastoma de yeyuno.

A patient with a jejunal leiomyoblastoma presented with lower gastrointestinal haemorrhage, a most unusual occurrence according to the literature. The provisional diagnosis was made by arteriography and confirmed pathologically. The characteristics of these tumours are analyzed and the management discussed.