Clinicopathological characteristics and outcome of nested carcinoma of the urinary bladder.

We present the clinicopathological features of 56 cases of the nested variant of urothelial bladder carcinoma. This is an uncommon variant of bladder cancer, recognized by the current WHO classification of urologic tumors. The nested component represented 100 % of the tumor in 24 cases. The architectural pattern of the tumor varied from solid expansile to infiltrative nests characterized by deceptively bland histologic features resembling von Brunn nests. Typical features of high-grade conventional urothelial carcinoma were present in 32 cases. Most neoplastic cells had nuclei of low to intermediate nuclear grade with occasional nuclear enlargement, most frequently seen in deep areas of tumor. The nested component expressed cytokeratins 7, 20, CAM5.2, and high molecular weight (34ßE12), p63, Ki67, p53, p27, and GATA3. Tumor extension was T1 (n = 9), minimally T2 (n = 10), T2a (n = 1), T2b (n = 4), T3a (n = 8), T3b (n = 13), and T4a (n = 11). On follow-up, 36 of patients died of or were alive with disease from 2 to 80 months (mean 21 months). Four patients died of other causes. Eleven other patients remained disease free. Univariate survival analysis showed no differences for nested carcinoma compared with conventional urothelial carcinoma. As in conventional urothelial carcinoma, in nested carcinoma of the bladder pT category defined different survival groups. In summary, nested variant of urothelial bladder carcinoma is typically associated with advanced stage. In samples of limited volume, it may be misdiagnosed as proliferation of von Brunn nests or other nested-like bladder lesions, delaying definitive therapy.

Primary renal osteosarcoma.

OBJECTIVES: To investigate primary osteosarcoma (osteogenic sarcoma) of the kidney, a rare and aggressive neoplasm. METHODS: We present clinical and pathologic features of three female patients, aged 50, 66, and 78 years, affected by primary osteosarcoma of the kidney. The diagnosis was made by H&E-stained samples from totally (cases 1 and 2) or partially (case 3) embedded tumors. RESULTS: Reported cases showed histologic features of low-grade (n = 1), chondroblastic (n = 1), and osteoblastic (n = 1) osteosarcoma. Tumor size ranged from 3 to 7 cm, and pT category was pT1a (n = 1), pT1b (n = 1), and pT3a (n = 1). Immunohistochemistry gave focal positive results with PAX2 and CD10 in case 1 and S100 in case 2. On follow-up, two patients were disease free at 25 and 68 months and one died of metastases. CONCLUSIONS: Surgically treated primary renal osteosarcoma might not be as aggressive as previously thought if diagnosed early with low pT status.

Urothelial dysplasia of the bladder: diagnostic features and clinical significance.

The 2004 World Health Organization classification system for urothelial neoplasia identifies urothelial dysplasia (low-grade intraurothelial neoplasia) as a premalignant lesion of the urothelium. Although diagnostic criteria of urothelial dysplasia have been improved in recent years, there is a frequent lack of interobserver reproducibility. Follow-up studies suggest that dysplasia is a marker for urothelial instability and disease progression in up to 19% of patients, thus supporting an active clinical follow-up in these patients. The main differential diagnosis of urothelial dysplasia includes flat urothelial lesions with atypia, mainly flat (simple) urothelial hyperplasia, reactive urothelial atypia, urothelial atypia of unknown significance, and urothelial carcinoma in situ (high-grade intraurothelial neoplasia). In most cases, morphologic features alone suffice for diagnosis. Some cases may require a panel of immunohistochemical antibodies consisting of cytokeratin 20, p53 and CD44 for diagnosis. We present pathologic features and clinical significance of urothelial dysplasia with emphasis on differential diagnosis from common flat urothelial lesions with atypia.

[Biobanking: the basis for molecular research in uro-oncology]. / Banco de tumores: la base para la investigación molecular en uro-oncología.

OBJECTIVES: The advances in cancer translational research, as well as the study of its changes and interactions, depend basically on the procurement of case series (individuals affected and non affected controls) which supply high quality samples and other associated data. Biobanks have shown they are indispensable tools for the advance of uro-oncological research. METHODS: Bibliographic review based on biobanks with focus on Urology. RESULTS AND CONCLUSIONS: Well-organized, large biobanks are a key element in research in Uro-oncology. The integration of theses resources with molecular sciences and various "omics", together with powerful available bioinformatic tools enable the advance in the knowledge of development of uro-oncological diseases, with strong implications at the time of very advanced therapeutic strategies. However,in Spain, these valuable collections of tissue material and biological fluids are usually not much in use, mainly due to fragmentation, low accessibility, lack of proper management strategies (such as lack of consensus about standard operative procedures), limited specific policies of use and distribution, as well as lack of a comprehensive base in which the research needs are reflected under interdisciplinar and multi-institutional focus. We must add the frequent ignorance of the high scientific potential of these institutions in the urological world. The development of the Spanish National Plan of Biobanks brings light for the better use of these materials by the uro-oncological community. We present a general view on the biobank topic, which may serve as a model for future debates about their use in uro-oncology. This approach is based in data from the literature and results of discussions in various international forums.

Banco de tumores: la base para la investigación molecular en uro-oncología / Biobanking: The basis for molecular research in Uro-Oncology

OBJETIVO: Los avances en la investigación traslacional del cáncer, así como el estudio de sus cambios e interacciones, dependen fundamentalmente de la obtención de series de casos (individuos afectados) y controles (no afectados) que proporcionan muestras de alta calidad y otros datos asociados. Los biobancos han mostrado ser una herramienta indispensable en el avance de la investigación uro-oncológica. MÉTODOS: Revisión de la literatura basada en biobancos con interés en urología. RESULTADOS Y CONCLUSIONES: Grandes biobancos bien organizados suponen un elemento clave en investigación en uro-oncologica. La integración de estos recursos con ciencias moleculares y diversas “omics”, junto a las poderosas herramientas bioinformáticas disponibles posibilita el avance en el conocimiento del desarrollo de la enfermedad uro-oncológica con fuertes implicaciones a la hora de planteamientos terapéuticos muy avanzados. En España, sin embargo, estas valiosas colecciones de material tisular y fluidos biológicos suelen estar poco utilizadas, debido principalmente a su fragmentación, poca accesibilidad, falta de estrategias de gestión adecuadas, como es la falta de consenso sobre los procedimientos operativos estándar, limitadas políticas específicas de utilización y distribución, así como falta de una amplia base en la cual se reflejen las necesidades de investigación bajo un enfoque interdisciplinar y multi-institucional; hemos de añadir el frecuente desconocimiento por el mundo urológico del elevado potencial científico de estas instituciones. El desarrollo del plan nacional español de biobancos supone una luz para el mejor aprovechamiento de este material por la comunidad uro-oncológica. A continuación se presenta una visión general en el tema de biobancos que puede servir como modelo para futuros debates sobre su utilización en uro-oncología. Esta aproximación está basada en datos de la literatura y resultados de discusión en diversos foros internacionales (AU)

OBJECTIVES: The advances in cancer translational research, as well as the study of its changes and interactions, depend basically on the procurement of case series (individuals affected and non affected controls) which supply high quality samples and other associated data. Biobanks have shown they are indispensable tools for the advance of uro-oncological research. METHODS: Bibliographic review based on biobanks with focus on Urology. RESULTS AND CONCLUSIONS: Well-organized, large biobanks are a key element in research in Uro-oncology. The integration of theses resources with molecular sciences and various “omics”, together with powerful available bioinformatic tools enable the advance in the knowledge of development of uro-oncological diseases, with strong implications at the time of very advanced therapeutic strategies. However, in Spain, these valuable collections of tissue material and biological fluids are usually not much in use, mainly due to fragmentation, low accessibility, lack of proper management strategies (such as lack of consensus about standard operative procedures), limited specific policies of use and distribution, as well as lack of a comprehensive base in which the research needs are reflected under interdisciplinar and multi-institutional focus. We must add the frequent ignorance of the high scientific potential of these institutions in the urological world. The development of the Spanish National Plan of Biobanks brings light for the better use of these materials by the uro-oncological community. We present a general view on the biobank topic, which may serve as a model for future debates about their use in uro-oncology. This approach is based in data from the literature and results of discussions in various international forums (AU)

Pathology of renal cell carcinoma: an update.

The use of classic and newer methodologies, including histopathology, electron microscopy, immunohistochemistry, cytogenetics, and molecular diagnostic techniques, has greatly influenced distinctions between various types of renal carcinoma. The most recent World Health Organization classification of renal neoplasms encompassed nearly 50 distinctive renal neoplasms. These categories have been expanded during recent years, incorporating newer histotypes, thus suggesting that the next revision of this classification will incorporate some of the recently recognized entities. In this review we examine the clinicopathologic and genetic features of renal carcinomas most often seen in clinical practice. Emphasis is placed on defining risk categories by incorporating pathologic predictive paradmeters and tumor histotypes. Since pathology of renal cell cancer is a rapidly evolving field, we also include brief comments on newer tumor variants for which there currently is not enough clinicopathologic information to permit classification as distinctive tumor histotypes.

El ancho de distribución eritrocitaria aporta valor pronóstico adicional en pacientes ambulatorios con insuficiencia cardiaca crónica / Red blood cell distribution width adds prognostic value for outpatients with chronic heart failure

Introducción y objetivos. El ancho de distribución eritrocitaria ha surgido como un marcador biológico con valor pronóstico en enfermedades cardiovasculares. Su valor adicional en la estratificación de riesgo de pacientes con insuficiencia cardiaca crónica no se encuentra establecido. Métodos. Se estudió consecutivamente a 698 pacientes ambulatorios con insuficiencia cardiaca crónica (edad, 71 años [intervalo intercuartílico, 62-77]; el 63% varones; fracción de eyección del ventrículo izquierdo, 40±14%). A su inclusión, se midió el ancho de distribución eritrocitaria y se registraron variables clínicas, bioquímicas y ecocardiográficas. La mediana de seguimiento fue 2,5 años [1,2-3,7]. Resultados. En total, fallecieron 211 pacientes y 206 precisaron hospitalización por insuficiencia cardiaca descompensada. El análisis de Kaplan-Meier mostró un incremento tanto de la probabilidad de muerte como de ingreso por insuficiencia cardiaca a través de cuartiles de ancho de distribución eritrocitaria (log rank, p<0,001). El análisis ROC identificó el valor de ancho de distribución eritrocitaria del 15,4% como mejor punto de corte, asociado a un incremento independiente del riesgo tanto de muerte (hazard ratio=2,63; intervalo de confianza del 95%, 2,01-3,45; p<0,001) como de ingreso por insuficiencia cardiaca (hazard ratio=2,37; intervalo de confianza del 95%, 1,80-3,13; p<0,001). Este valor predictivo se mantuvo con o sin anemia. Además, la adición del ancho de distribución eritrocitaria a la estratificación de riesgo de muerte o ingreso por insuficiencia cardiaca a 1 año se asoció con una mejora tanto del índice relativo de discriminación integrada (33%; p<0,001) como de la reclasificación neta de eventos (10,3%; p=0,001). Conclusiones. El ancho de distribución eritrocitaria es un marcador de riesgo independiente y añade información pronóstica sobre pacientes ambulatorios con insuficiencia cardiaca crónica. Los hallazgos indican su incorporación al manejo de estos pacientes (AU)

Introduction and objectives. Red blood cell distribution width has emerged as a new prognostic biomarker in cardiovascular diseases. Its additional value in risk stratification of patients with chronic heart failure has not yet been established. Methods. A total of 698 consecutive outpatients with chronic heart failure were studied (median age 71 years [interquartile range, 62-77], 63% male, left ventricular ejection fraction 40 [14]%). On inclusion, the red cell distribution width was measured and clinical, biochemical, and echocardiographic variables were recorded. The median follow-up period was 2.5 years [interquartile range, 1.2-3.7]. Results. A total of 211 patients died and 206 required hospitalization for decompensated heart failure. Kaplan-Meier analysis showed an increase in the probability of death and hospitalization for heart failure with red cell distribution width quartiles (log rank, P<.001). A ROC analysis identified a red cell distribution width of 15.4% as the optimal cut-off point for a significantly higher risk of death (P<.001; hazard ratio=2.63; 95% confidence interval, 2.01-3.45) and hospitalization for heart failure (P<.001; hazard ratio=2.37; 95% confidence interval, 1.80-3.13). This predictive value was independent of other covariates, and regardless of the presence or not of anaemia. Importantly, the addition of red cell distribution width to the clinical risk model for the prediction of death or hospitalization for heart failure at 1 year had a significant integrated discrimination improvement of 33% (P<.001) and a net reclassification improvement of 10.3% (P=.001). Conclusions. Red cell distribution width is an independent risk marker and adds prognostic information in outpatients with chronic heart failure. These findings suggest that this biological measurement should be included in the management of these patients (AU)

Lymphocytic vasculitis of the prostate transition zone.

UNLABELLED: Study Type--Pathology (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Lymphocytic vasculitis of the prostate is an exceedingly rare form of localised vasculitis that presents without systemic involvement, and is illustrated with anecdotal case reports; often as localised polyarteritis nodosa-like vasculitis. True incidence and clinical significance of lymphocytic vasculitis of the prostate in surgical specimens is virtually unknown. The present findings support that lymphocytic vasculitis of the prostate was present in 67 (12.4%) of 540 specimens. Lymphocytic vasculitis of the prostate was present in 14 (93.3%) of 15 specimens with prostatic infarction (P < 0.001) with a risk of 124.68 (OR [odds ratio]; 95% CI [confidence interval] 16.07-967.07) as compared with BPH cases not associated with lymphocytic vasculitis. OBJECTIVE: • To present our experience of lymphocytic vasculitis of the prostate in men with benign prostatic hyperplasia (BPH) without systemic involvement, as this is an exceedingly rare form of localised vasculitis and the incidence in surgical specimens and clinical significance of lymphocytic vasculitis is virtually unknown. PATIENTS AND METHODS: • A sequential cohort series of 540 surgical specimens removed because of BPH-related symptoms, including simple prostatectomy (374 men) and transurethral resection of the prostate (166), comprised the study group. • All men had histological diagnosis of BPH and received surgical therapy only. None of the men had had previous surgery or granulomatous prostatitis. • The mean (range) age at diagnosis was 67.8 (38-89) years. RESULTS: • Lymphocytic vasculitis of the prostate was present in 67 (12.4 %) of 540 specimens. It was seen in a variable number of small- to medium-sized parenchyma arteries with segmental to transmural lymphocytic inflammation, within the morphological spectrum of a polyarteritis nodosa (PAN)-like lesion seen at the periphery of BPH nodules. • In four cases, focal fibrinoid necrosis was seen in vessels with otherwise typical lymphocytic vasculitis features. Immunohistochemical staining showed a T cell predominant polymorphic cellular infiltrate with a minor component of B cells and monocytes. Six cases additionally had eosinophils (<1% of inflammatory cells). • Lymphocytic vasculitis of the prostate was present in 14 (93.3%) of 15 specimens with prostatic infarction (P < 0.001) with a risk of 124.68 (odds ratio [OR]; 95% confidence interval [CI] 16.07-967.07) as compared with BPH cases not associated with lymphocytic vasculitis. Logistic regression multivariate analysis selected both lymphocytic vasculitis of the prostate and patient age as significant predictors of prostate infarction with lymphocytic vasculitis being the most significant (P < 0.001; OR 128.12; 95% CI 16.298-1007.202). Follow-up information was available in all cases, range 2-16 years, and none of the patients developed systemic disease. • A validation set of 1665 additional cases including radical prostatectomy, cystoprostatectomy, and needle biopsies showed lymphocytic vasculitis of the prostate being associated to prostate infarction on univariate and multivariate logistic regression (P < 0.001; OR 228.34; 95% CI 45.17-1154.22) analyses. CONCLUSIONS: • Lymphocytic vasculitis in men with BPH is associated with prostatic infarction and should be considered a form of localised vasculitis with PAN-like morphology that does not necessitate additional evaluation for systemic disease. • The potential clinical relevance of lymphocytic vasculitis warrants further investigation.

Red blood cell distribution width adds prognostic value for outpatients with chronic heart failure.

INTRODUCTION AND OBJECTIVES: Red blood cell distribution width has emerged as a new prognostic biomarker in cardiovascular diseases. Its additional value in risk stratification of patients with chronic heart failure has not yet been established. METHODS: A total of 698 consecutive outpatients with chronic heart failure were studied (median age 71 years [interquartile range, 62-77], 63% male, left ventricular ejection fraction 40 [14]%). On inclusion, the red cell distribution width was measured and clinical, biochemical, and echocardiographic variables were recorded. The median follow-up period was 2.5 years [interquartile range 1.2-3.7]. RESULTS: A total of 211 patients died and 206 required hospitalization for decompensated heart failure. Kaplan-Meier analysis showed an increase in the probability of death and hospitalization for heart failure with red cell distribution width quartiles (log rank, P<.001). A ROC analysis identified a red cell distribution width of 15.4% as the optimal cut-off point for a significantly higher risk of death (P<.001; hazard ratio=2.63; 95% confidence interval, 2.01-3.45) and hospitalization for heart failure (P<.001; hazard ratio=2.37; 95% confidence interval, 1.80-3.13). This predictive value was independent of other covariates, and regardless of the presence or not of anaemia. Importantly, the addition of red cell distribution width to the clinical risk model for the prediction of death or hospitalization for heart failure at 1 year had a significant integrated discrimination improvement of 33% (P<.001) and a net reclassification improvement of 10.3% (P=.001). CONCLUSIONS: Red cell distribution width is an independent risk marker and adds prognostic information in outpatients with chronic heart failure. These findings suggest that this biological measurement should be included in the management of these patients. Full English text available from:www.revespcardiol.org.

[An atypical case of massive gastrointestinal hemorrhage]. / Caso atípico de hemorragia digestiva masiva.

Gastrointestinal stromal tumors (GIST) are an infrequent cause (<1%) of severe gastrointestinal hemorrhage. Treatment is mainly surgical through complete tumoral resection. We report the case of a 29-year-old woman who presented to the emergency room with severe gastrointestinal bleeding manifested by melena. On physical examination the patient had a painless, palpable mass in the left abdomen. Esophagogastroduodenoscopy, computed tomography, angiography and urgent surgical intervention led to diagnosis of a jejunal GIST.

Caso atípico de hemorragia digestiva masiva / An atypical case of massive gastrointestinal hemorrhage

Los tumores estromales gastrointestinales (GIST) son una causa poco frecuente (< 1%) de hemorragia digestiva masiva. El tratamiento es fundamentalmente quirúrgico mediante la extirpación completa del tumor. Exponemos el caso de una mujer de 29 años de edad que acudió a urgencias al presentar un cuadro clínico compatible con hemorragia digestiva grave en forma de melenas. A la exploración física se apreció una masa abdominal indolora y no pulsátil. Tras realizar una endoscopia digestiva alta, una tomografía computarizada, una arteriografía y una intervención quirúrgica urgente, se llega al diagnóstico de GIST yeyunal

Gastrointestinal stromal tumors (GIST) are an infrequent cause (<1%) of severe gastrointestinal hemorrhage. Treatment is mainly surgical through complete tumoral resection. We report the case of a 29-year-old woman who presented to the emergency room with severe gastrointestinal bleeding manifested by melena. On physical examination the patient had a painless, palpable mass in the left abdomen. Esophagogastroduodenoscopy, computed tomography, angiography and urgent surgical intervention led to diagnosis of a jejunal GIST

[Detection of domestic violence against women. Survey in a primary health care clinic]. / Violencia doméstica contra la mujer. Una encuesta en consultorios de atención primaria.

According to Pan American Health Organization nearly 50% of women suffer chronic domestic violence in Latin America. We evaluated the prevalence of gender based violence (GBV) in women assisted in a University Outpatient Clinic in Buenos Aires. We used a survey originally developed by the International Planned Parenthood Federation (IPPF) in Spanish. The survey was distributed to a consecutive sample of women more than 18 years of age who attended the clinic. Participants were randomized to fill out the questionnaire anonymously (self-administered) or during an interview with the physician in order to test the sensitivity of these two different modalities of data collection. Of 360 eligible women 270, (75%) completed the questionnaire. The respondents had a median age of 45.4 years, only 33% had more than 7 years of formal education and 48% did not live with a partner. Of the 270 respondents, 120 (44%) women reported mistreatment at least once during their lifetime. Of these, 108 (40%) reported psychological GBV, 53 physical GBV and 45 reported sexual GBV. Most of the respondents suffered more than one type of violence. 46 (17%) women reported sexual abuse during childhood, 219 (81%) of participants never had been asked by their physician about domestic violence. Women interviewed by the physician reported GBV more frequently than those completing the self-administered survey (p <0.005). The survey developed by the IPPF is considered a useful tool for screening in a clinical setting.

Violencia doméstica contra la mujer. Una encuesta en consultorios de atención primaria. / [Detection of domestic violence against women. Survey in a primary health care clinic]

According to Pan American Health Organization nearly 50

of women suffer chronic domestic violence in Latin America. We evaluated the prevalence of gender based violence (GBV) in women assisted in a University Outpatient Clinic in Buenos Aires. We used a survey originally developed by the International Planned Parenthood Federation (IPPF) in Spanish. The survey was distributed to a consecutive sample of women more than 18 years of age who attended the clinic. Participants were randomized to fill out the questionnaire anonymously (self-administered) or during an interview with the physician in order to test the sensitivity of these two different modalities of data collection. Of 360 eligible women 270, (75

) completed the questionnaire. The respondents had a median age of 45.4 years, only 33

had more than 7 years of formal education and 48

did not live with a partner. Of the 270 respondents, 120 (44

) women reported mistreatment at least once during their lifetime. Of these, 108 (40

) reported psychological GBV, 53 physical GBV and 45 reported sexual GBV. Most of the respondents suffered more than one type of violence. 46 (17

) women reported sexual abuse during childhood, 219 (81

) of participants never had been asked by their physician about domestic violence. Women interviewed by the physician reported GBV more frequently than those completing the self-administered survey (p <0.005). The survey developed by the IPPF is considered a useful tool for screening in a clinical setting.