Effects of androgen deprivation therapy on elderly men with high-risk prostate cancer: PROSARC observational study.

INTRODUCTION: Prostatic carcinoma (PC) is a frequent neoplasm in elderly patients. Although androgen deprivation is associated with survival benefits, it is also related to adverse effects such as osteoporosis, frailty, or sarcopenia, which can negatively affect the patient's quality of life. This study aims to quantify and evaluate the prevalence of osteoporosis, frailty, or sarcopenia in elderly PC patients before and after androgen deprivation. We present data from an interim analysis. MATERIALS AND METHODS: PROSARC is a national (Spain) prospective observational study (May-2022-May-2025) still in progress in 2 hospitals. It includes patients with high-risk PC, aged ≥70 years, non-candidates for local treatment and scheduled to start androgen deprivation therapy. The following variables are analyzed: comorbidity, frailty (Fried frailty phenotype criteria), osteoporosis, sarcopenia (EWGSOP2), fat mass and muscle mass, before treatment and after 6 months of follow-up. RESULTS: A 6-month follow-up was completed by 12/25 included patients (mean age, 84 years), with a high baseline prevalence of pre-frailty/frailty (67.7%), sarcopenia (66.7%) and osteoporosis (25%). Treatment did not significantly alter these variables or comorbidity. We observed changes in body mass index (p=0.666), decreased mean value of appendicular muscle mass (p=0.01) and increased percentage of fat mass (p=0.012). CONCLUSION: In patients with high-risk PC, advanced age and a considerable prevalence of osteoporosis, frailty and sarcopenia, androgen deprivation (ADT; 6 months) produces decreased muscle mass without impact on the incidence of the known adverse effects of androgen deprivation.

Cistoscopia en la bilharziasis vesical / Cistoscopy in bladder bilharziasis

No disponible

Carcinoma de los ductos de Bellini. Aportación de dos nuevos casos / Bellini duct carcinoma: report of two cases

Objetivo: Presentamos dos casos de carcinoma de ductos de Bellini diagnosticados en nuestro servicio en un plazo de seis meses. Método/resultado: El caso nº1 es una mujer de 75 años de edad en la que un TAC, realizado por estudio de patología digestiva, mostró una masa en el riñón izquierdo que infiltraba grasa perirrenal. El caso nº2 es un varón de 72 años que al realizar estudio por TVP bilateral de miembros inferiores, se evidenció en el TAC una lesión renal derecha dependiente de la pelvis, mal definida, con afectación de la vena cava y renal derecha. Tras la realización de nefrectomía radical en ambos casos, se confirmó el diagnóstico anatomopatológico de carcinoma de ductos de Bellini. Conclusión: El carcinoma de los ductos de Bellini es una rara variedad de tumor renal que deriva de los ductos colectores de la médula renal. Caracterizado tanto por su agresividad, como por su peculiar diagnóstico, histológico e inmunohistoquímico, que lo diferencia del resto (AU)

Objective: We report two cases of collecting duct carcinoma that were diagnosed in our hospital in a six-month period. Methods/results: The first case was a 75-years-old woman showing in CT scan a mass in the left kidney which infiltrated perinephric fat. The second case was a 72-years-old that showed in a CT scan a right renal pelvis lesion, involving inferior vena cava and renal vein. After surgical resection by radical nephrectomy in both cases, we confirmed the histological diagnosis of collecting duct carcinoma. Conclusions: Collecting duct carcinoma is a rare variant of renal cell carcinoma which originates from the epithelium of the collecting tubule. It is characterized by both its aggressiveness and peculiar histological and inmunohistochemical diagnosis, that separates it from the rest of renal tumors (AU)

[Vesical schistosomiasis, case report and Spanish literature review]. / Esquistosomiasis vesical, aportación de un caso y revisión de la literatura española.

Urinary schistosomiasis is an infection caused by parasite, Schistosoma haematobium. Squistosomiasis is an endemic disease in Africa and Middle East. We are presenting a case of a young immigrant male from Mali that came to our clinic with hematuria and miccional irritative syndrome during a year. Parasitological study reported Schimosoma's eggs and ecography showed a possible vesical newformation. After RTU, anatomopatological study confirms the presence of a vesical esquistosomiasis. Now pacient is asyntomatic after he was treated with Praziquantel.

Esquistosomiasis vesical, aportación de un caso y revisión de la literatura española / Vesical schistosomiasis, case report and spanish literature review

La esquistosomiasis urinaria es una parasitosis provocada por Schistosoma haematobium. Es una enfermedad endémica que afecta a casi toda África y Oriente Medio. Presentamos un caso de un varón joven emigrante de Mali que consultó por hematuria terminal y síndrome miccional irritativo ocasional de un año de evolución. El estudio parasitológico en orina detectó huevos de Schistosoma y la ecografía objetivó una posible neoformación vesical. Tras RTU, el análisis anatomopatológico confirmó la presencia de esquistosomiasis vesical. Actualmente, el paciente está asintomático tras tratamiento con Praziquantel

Urinary schistosomiasis is an infection caused by parasite, Schistosoma haematobium. Squistosomiasis is an endemic disease in Africa and Middle East. We are presenting a case of a young immigrant male from Mali that came to our clinic with hematuria and miccional irritative syndrome during a year. Parasitological study reported Schimosoma´s eggs and ecography showed a possible vesical newformation. After RTU, anatomopatological study confirms the presence of a vesical esquistosomiasis. Now pacient is asyntomatic after he was treated with Praziquantel

[Growing incidence in renal cell carcinoma]. / Incidencia creciente en el carcinoma de células renales.

OBJECTIVES: To analyze the change in the behavior of renal cell carcinoma for its presentation, treatment, histology and mortality during a 17 year period. MATERIAL AND METHOD: Retrospective study on 212 patients diagnosed with renal cell carcinoma in our Department from the year 1988 up to 2004, analyzing the clinical and demographic data and comparing them to each other according to two periods: 1988-1996 and 1997-2004. RESULTS: An increase has been appreciated in the incidence of renal tumors in the second period and in a same way an increase in the incidental diagnosis and in the practice of nephron sparing surgery. Clear cell type was the most frequent in both periods and tumoral size was higher in the first period than in second. TNM stage I was the most frequent, although in first period it was higher percentage of stage IV. Cause-specific mortality has increased in the last years. CONCLUSION: An increase is appreciated in the incidence of renal cell tumors. Although the diagnosis is in earlier stages, a descent in the mortality has not been found.

Incidencia creciente en el carcinoma de células renales / Growing incidence in renal cell carcinoma

Objetivos: Analizar el cambio en el comportamiento del carcinoma de células renales en cuanto a su modo de presentación, tratamiento, anatomía patológica y mortalidad durante un periodo de 17 años. Material y método: Estudio retrospectivo sobre 212 pacientes intervenidos en nuestro Servicio por carcinoma de células renales desde el año 1988 hasta 2004, analizando los datos clínico-demográficos y comparándolos entre sí según dos periodos: 1988-1996 y 1997-2004. Resultados: Se ha apreciado un aumento en la incidencia de tumores renales en el segundo periodo y de igual manera un aumento en el diagnóstico incidental y en la práctica de cirugía conservadora de parénquima. El tipo histológico más frecuente fue el de células claras en ambos periodos y el tamaño tumoral era mayor en el primer periodo que en el segundo. El estadio tumoral más frecuente fue el I, aunque en el primer periodo se encontró mayor porcentaje de estadios IV. La mortalidad causa-específica ha aumentado en los últimos años. Conclusión: Se aprecia un aumento en la incidencia de tumores renales y, aunque estos se diagnostican en estadios más precoces, no se ha producido un descenso en la mortalidad

Objectives: To analyze the change in the behavior of renal cell carcinoma for its presentation, treatment, histology and mortality during a 17 year period. Material and method: Retrospective study on 212 patients diagnosed with renal cell carcinoma in our Department from the year 1988 up to 2004, analyzing the clinical and demographic data and comparing them to each other according to two periods: 1988-1996 and 1997-2004. Results: An increase has been appreciated in the incidence of renal tumors in the second period and in a same way an increase in the incidental diagnosis and in the practice of nephron sparing surgery. Clear cell type was the most frequent in both periods and tumoral size was higher in the first period than in second. TNM stage I was the most frequent, although in first period it was higher percentage of stage IV. Cause-specific mortality has increased in the last years. Conclusion: An increase is appreciated in the incidence of renal cell tumors. Although the diagnosis is in earlier stages, a descent in the mortality has not been found

[Entero-neobladder ileal fistula: two cases report]. / Fístula entero-neovejiga ileal: a propósito de dos casos.

Fistulas between the orthotopic reservoir and the gastrointestinal tract have low incidence (1.5-2%). Simptomatology is variable, but it's frecuent to find fecaluria. Among 90 new intestinal bladders we show two fistule of new bladder to ileo, with nest postoperatory diagnosis, using retrograde cystografy; one was resolved with next postoperative treatment and the other with open surgery.

Fístula entero-neovejiga ileal: a propósito de dos casos / Entero-neobladder ileal fistula: two cases report

Las fístulas entre el reservorio ortotópico y el tracto intestinal son de escasa incidencia (1,5-2%). La sintomatología es variable, pero frecuentemente existe fecaluria. Entre 90 neovejigas intestinales, presentamos dos fístulas de neovejiga a íleon, diagnosticadas en el postoperatorio próximo, mediante cistografía retrógrada; una resuelta con tratamiento conservador, y otra con cirugía abierta (AU)

Fistulas between the orthotopic reservoir and the gastrointestinal tract have low incidence (1,5-2%). Simptomatology is variable, but it’s frecuent to find fecaluria. Among 90 new intestinal bladders we show two fistule of new bladder to ileo, with nest postoperatory diagnosis, using retrograde cystografy; one was resolved with next postoperative treatment and the other with open surgery (AU)

[Urachal pathology: an overview review and report of three clinical cases]. / Patología del uraco: revisión de conjunto y presentación de tres casos.

With the use of these two clinical cases (cyst and urachal adenocarcinoma) we did an overview of the urachal pathology. The urachus cyst is usually asyntomathic, it's detected randomly when we do other diagnostic tests or when we have any complications. The urachal adenocarcinoma is a rare pathology, it usually exhibit hematuria and we need to follow the same diagnostic tools as we use in vesical tumors (cystoscopy and transurethral vesical resection). Adenocarcinoma of the dome of the bladder is the main differential diagnosis. Partial cystectomy is the first choice treatment. Quimiotheraphy and radiotheraphy offer poor results.

[Problem-based learning in urology training. The Faculty of Medicine of the Universidad de Castilla-La Mancha model]. / El aprendizaje basado en problemas en la enseñanza de la urologia. Modelo de la Facultad de Medicina de la Universidad de Castilla-La Mancha.

Ongoing changes in the social, economic, technological and scientific realms have generated new needs and led various organizations to suggest that educational institutions should reorient their educational strategies toward developing effective professionals with the skills to meet these needs. These "modern" strategies include problem-based learning, in which the student seeks and selects information, analyzes the data obtained, integrates both prior and newly acquired knowledge, and, finally, offers diagnostic and therapeutic options to resolve the problem posed, as would occur in professional practice. With this approach, prior skills and practical experience form the foundation of learning. Problem-based learning incorporates some aspects of cognitive psychology, a model that mainly centers on the nature of the knowledge structures found in active memory, the processes involved in information storage and retrieval and the various factors that activate these processes. At the Faculty of Medicine of the Universidad de Castilla-La Mancha, urology is part of a core subject (Medical and Surgical Pathology II) taught in the fifth year of coursework together with nephrology. Each course includes approximately 75 students, divided into five groups. The rotation lasts six weeks, with students spending a mean of two hours a day on theory (nephrology and/or urology) and the remaining time on rotations in the various activities: three weeks in nephrology and three weeks in urology. Upon completion of the rotation, the students write a combined theoretical examination with 100 multiple-choice questions (50 on urology) and take a practical skills examination. At the end of the course, another practical test consisting of an objective, structured clinical examination is taken, in which standard patients are used and the professor directly assesses the level of skills acquired with a "real" case.

Patología del uraco: revisión de conjunto y presentación de tres casos / Urachal pathology: an overview revision and presentation of three clinical cases

Con la presentación de estos dos casos (quiste y adenocarcinoma de uraco) realizamos una revisión de conjunto de la patología uracal. El quiste de uraco suele tener un curso asintomático, descubriéndose de manera casual al realizar otras pruebas diagnósticas o cuando surgen complicaciones del mismo. El adenocarcinoma uracal es una entidad rara, se presenta habitualmente con hematuria debiendo seguir el mismo protocolo diagnóstico que para los tumores vesicales (cistoscopia y RTU-vesical). Ha de plantearse el diagnóstico diferencial con el adenocarcinoma de cúpula vesical. La cistectomía parcial es el tratamiento de elección. La quimioterapia y radioterapia ofrecen pobres resultados (AU)

With the use of these two clinical cases (cyst and urachal adenocarcinoma) we did an overview of the urachal pathology. The urachus cyst is usually asyntomathic, it´s detected randomly when we do other diagnostic tests or when we have any complications. The urachal adenocarcinoma is a rare pathology, it usually exhibit hematuria and we need to follow the same diagnostic tools as we use in vesical tumors (cystoscopy and transurethral vesical resection). Adenocarcinoma of the dome of the bladder is the main differential diagnosis. Partial cystectomy is the first choice treatment. Quimiotheraphy and radiotheraphy offer poor results (AU)

El aprendizaje basado en problemas en la enseñanza de la urología. Modelo de la Facultad de Medicina de la Universidad de Castilla-La Mancha / Problem-based learning in urology training. The faculty of medicine of the Universidad de Castilla-La Mancha model

Las nuevas necesidades derivadas de los actuales cambios sociales, económicos, tecnológicos, científicos, etc..., han hecho que distintos organismos hayan sugerido a los estamentos educativos la necesidad de desarrollar cambios en las estrategias educativas orientados al desarrollo de un profesional eficaz con competencias adaptadas a estas necesidades. Dentro de las estrategias “modernas” se encuentra la enseñanza basada en problemas o aprendizaje por problemas (PBL), mediante la cual el estudiante busca y selecciona la información, razona e integra los conocimientos previos y adquiridos, dando finalmente unas posibilidades diagnósticas y terapéuticas al problema planteado, tal y como se va a enfrentar en su actividad profesional. Los conocimientos previos y la actividad constituyen los pilares fundamentales del aprendizaje. El PBL incorpora algunos de los aspectos de la psicología cognitiva, modelo cuya parte principal determina la naturaleza de las estructuras del conocimiento que se encuentran en la memoria activa, en los procesos de almacenamiento y recuperación de la información y los diversos factores que lo activan. La urología en la Facultad de Medicina de la Universidad de Castilla-La Mancha forma parte de una asignatura troncal (Patología Médica y Quirúrgica II) que se imparte durante el quinto curso. La urología se desarrolla integrada con nefrología. El número de alumnos por curso es aproximadamente 75 divididos en 5 grupos. La “rotación” dura seis semanas durante las cuales los estudiantes tienen una media de 2 horas diarias de teoría (ya sean de nefrología y/o urología) y el resto son rotatorias por distintas actividades: tres semanas en nefrología y tres semanas en urología. Al finalizar la rotación los udiantes realizan un examen teórico conjunto con 100 preguntas de respuestas múltiple (50 de urología) y un examen práctico de las habilidades. A final de curso existe otra prueba práctica (OSCE: examen clínico objetivo y estructurado) con la utilización de pacientes estandarizados, debiendo el profesor evaluar de forma directa el nivel de competencias adquiridas ante un “caso real”

Ongoing changes in the social, economic, technological and scientific realms have generated new needs and led various organizations to suggest that educational institutions should reorient their educational strategies toward developing effective professionals with the skills to meet these needs. These “modern” strategies include problem-based learning, in which the student seeks and selects information, analyzes the data obtained, integrates both prior and newly acquired knowledge, and, finally, offers diagnostic and therapeutic options to resolve the problem posed, as would occur in professional practice. With this approach, prior skills and practical experience form the foundation of learning. Problem-based learning incorporates some aspects of cognitive psychology, a model that mainly centers on the nature of the knowledge structures found in active memory, the processes involved in information storage and retrieval and the various factors that activate these processes.At the Faculty of Medicine of the Universidad de Castilla-La Mancha, urology is part of a core subject (Medical and Surgical Pathology II) taught in the fifth year of coursework together with nephrology. Each course includes approximately 75 students, divided into five groups. The rotation lasts six weeks, with students spending a mean of two hours a day on theory (nephrology and/or urology) and the remaining time on rotations in the various activities: three weeks in nephrology and three weeks in urology. Upon completion of the rotation, the students write a combined theoretical examination with 100 multiple-choice questions (50 on urology) and take a practical skills examination. At the end of the course, another practical test consisting of an objective, structured clinical examination is taken, in which standard patients are used and the professor directly assesses the level of skills acquired with a “real” case

p53 Gene mutations in superficial bladder cancer.

OBJECTIVES: To assess the presence of p53 gene mutations in superficial tumors of the urinary bladder (transitional cell carcinoma) and their relationship to classic prognostic factors for cancer recurrence and progression. To analyze the implication of these mutations on the P53 protein structure. MATERIALS AND METHODS: Observational, cross-sectional study of 90 consecutive patients, 60 with superficial transitional cell carcinoma (pTa and pT1) and 30 without neoplastic disease (control group). Samples of bladder tumor and control normal mucosa were analyzed by polymerase chain reaction-single-strand conformation polymorphism (PCR-SSCP) to detect p53 mutations in exons 5-9. Automatic sequencing was used to characterize the mutations and their effect on the P53 protein was analyzed. Bivariate analysis was used to assess the association with other prognostic factors. RESULTS: PCR-SSCP found no mutations in any control group patient, whereas 38.3% of patients with superficial transitional cell carcinoma had one or more mutations in the exons analyzed. Thirty mutations were sequenced; all were point mutations and 86.67% were considered relevant for the P53 structure. A total of 93.3% of the mutations were located in highly conserved regions and 73.3% in mutational hot spots. The highest cell differentiation grades and pT1 stage were associated with a higher incidence of p53 gene mutations. Previous recurrences and other tumor-related histological variables were not associated with a higher percentage of mutations. CONCLUSION: Mutations at p53 did not appear in healthy bladder mucosa and were significantly more frequent in pT1 and high-grade (G-II and G-III) tumors. All mutations detected were point mutations and most caused considerable P53 structural abnormalities, implying major repercussions on P53 function. These data suggest that certain p53 mutations may have prognostic value, even though they were not associated with other classic recurrence and tumor progression parameters. Future analyses of the progress of patients with superficial bladder transitional cell carcinoma and mutated p53 will help clarify this aspect.

[Surgery of large residual mass after chemotherapy in advanced testicular germ cell tumor]. / Cirugía de gran masa residual tras quimioterapia en tumor germinal testicular avanzado.

Treatment for testicular tumours has progress in such a manner in the last years that high cure percentages can at present be achieved. After chemotherapy, in most cases, residual mass can appear. In this cases surgery is considered a viable therapeutic option although it implies an advanced surgical training since it is a complex technique and implies serious implications. We submit the case of a patient who presented a large residual mass from a testicular germ cell tumour after being treated with orquiectomía and chemotherapy. Surgery was performed resulting in total and radical extirpation of residual mass.

[Nephron-sparing surgical treatment in renal tumors]. / Cirugía conservadora de parénquima en los tumores renales.

OBJECTIVE: A retrospective study on the nephron-sparing surgical treatment in patients with renal tumors, and in addition a literature review on the subject. MATERIAL AND METHODS: Since January 1988 until February 2002, 44 partial nephrectomies have been carried out in our unit because of renal tumors in 43 patients. The clinical protocols of these 43 patients have been reviewed, with an analysis of various clinical-pathological parameters, and utilizing in this analysis percentages, central tendency measures and dispersion and confidence intervals. RESULTS: The average age of the patients was 55.8 years (19-76), and 29 patients were males. Elective partial nephrectomy was carried out in 79.5% of the patients, while in the rest they were submitted to imperative surgery for various causes. The diagnosis of the tumors was mostly as an incidental finding upon carrying out some diagnostic test by another cause (68.2%). In the symptomatic cases, the most common presentation was the combination of pain and hematuria (11.4%). Histopathological study revealed malignant neoplasms in 88.7%, most of them (61.4%) clear cell carcinomas. A Furhman grade 2 was observed in 76.3% of tumors. The average size of the renal masses was of 4.53 cm (1,5-11). As a whole, 61.5% were pT1, 33.3% were pT2 and only one case was pT3. Operative complications were observed in 11.4% of the cases and postoperative complications in 25%. No patient showed local or distant recurrence, and all of them survived disease-free. A patient died after 74 months of the surgery for causes not related to the disease. Average follow-up was 49.77 months (1-168). CONCLUSIONS: Renal nephron-sparing surgery is such a valid therapeutic option as radical nephrectomy in selected patients with renal tumors, since the cancer-specific survival is 100%, which means that this can be considered a therapeutic indication even in patients with healthy contralateral kidney.

Cirugía de gran masa residual tras quimioterapia en tumor germinal testicular avanzado / Surgery of a large retroperitoneal residual mass after chemotherapy in advanced testicular germ cell tumour

El tratamiento de los tumores testiculares ha avanzado de tal manera en los últimos años que se consiguen altos porcentajes de curación. Tras la quimioterapia, en muchos casos aparecen masas residuales que son susceptibles de cirugía como opción terapéutica que obtiene buenos resultados, pero que precisa un grado de entrenamiento quirúrgico avanzado ya que es una técnica dificultosa y con importantes complicaciones. Presentamos el caso de un paciente que tras orquiectomía y quimioterapia por tumor germinal testicular avanzado, presentó masa residual de gran tamaño que precisó cirugía de la misma, consiguiéndose la extirpación radical (AU)

Treatment for testicular tumours has progress in such a manner in the last years that high cure percentages can at present be achieved. After chemotherapy, in most cases, residual mass can appear. In this cases surgery is considered a viable therapeutic option although it implies an advanced surgical training since it is a complex technique and implies serious implications. We submit the case of a patient who presented a large residual mass from a testicular germ cell tumour after being treated with orquiectomía and chemotherapy. Surgery was performed resulting in total and radical extirpation of residual mass (AU)

Prognostic implications of p53 gene mutations in bladder tumors.

PURPOSE: Alterations in the p53 gene related to neoplastic progression were studied in tumor tissue samples from patients with transitional cell carcinoma and correlated with classic staging parameters. On this basis, biological characterization of the tumor was performed to establish subgroups of patients at high risk and those with a more favorable prognosis. MATERIALS AND METHODS: This observational, analytical and cross-sectional study included 115 patients divided into 4 homogeneous groups of 1-control, 2-primary superficial transitional cell carcinoma, 3-recurrent superficial transitional cell carcinoma, and 4-infiltrative transitional cell carcinoma. DNA was obtained from tumor tissue samples and polymerase chain reaction-single strand conformational polymorphism analysis was performed on exons 5 to 9 of the p53 gene. Samples showing mutations were submitted to automatic sequencing. Statistics included bivariate analysis and logistic regression. RESULTS: Of the tumors the 63.8% were superficial and 37.2% were infiltrative transitional cell carcinoma. Of the infiltrative tumors 23.5% (8 of 34) resulted from recurrent transitional cell carcinoma. Mutations were found in samples from 46.8% of patients, all with bladder tumors. There was a trend toward increasing appearance of mutations as the size of the tumor, number of tumor implants, degree of dedifferentiation and stage of local infiltration increased. The presence of mutations in p53 was 2.5 times greater in infiltrative tumors than in low stage and 4.3 times greater in moderate to high grade than in low grade tumors. All mutations found were point mutations and 79.25% provoked severe alterations in protein structure. CONCLUSIONS: Mutations in the p53 gene are mainly point mutations that aggregate in hot spots, and provoke genetic instability and substantial changes that alter p53 function, implying a trend to tumor progression and dissemination (with a greater proportion of mutations in high stage high grade tumors). Since a large percentage of bladder tumors are under staged, analysis of p53 gene mutations could be useful as a factor for prognosis and therapeutic decisions.

[Pheochromocytoma of the organ of Zuckerkandl. Apropos of a case]. / Feocromocitoma del órgano de Zuckerkandl. A propósito de un caso.

INTRODUCTION: Extraadrenal pheochromocytomae represent 17-18% of pheochromocytomae, 85% of which are located infradiaphragmaticaly and generally wherever there is cromaffin tissue, as in this case, located at the organ of Zuckerkand. They can also appear in the context of family syndromes, i.e. phacomatosis and MEN (IIA and IIB). CLINICAL CASE: The authors present a case of pheochromocytoma located in the organ of Zuckerkand, diagnosed in the course of uncontroled HBP. Diagnosis was achieved by metanephrine determinations and radiological tests (ultrasound, CAT and MIBG). This patient was surgically treated by exeresis of the lession previous alpha and beta adrenergic blockade with phenoxybenzamine and propanolol. Currently this patient is asymptomatic with normal blood pressor and metanephrines blood levels. DISCUSSION: Extraadrenal pheochromocytomae are usually located in superior paraaortic infradiaphragmatic region. The grade of malignancy must be established by histopathological findings, local recidives and metastasis. After clinical suspicion and the finding of a retroperitoneal mass with ultrasound, CAT and/or MRI, MIBG must be performed to confirm the diagnosis as well as to leave out possible tumours at distance. Treatment is surgery previous blockade of cathecolamines secretion by the preoperative administration of alpha blockers, with or without beta blockers.