Xanthogranulomatous Ureteritis: A Diagnostic Challenge in a Patient with Bladder Cancer.

Xanthogranulomatous ureteritis is a very rare process characterized by the presence of foamy histiocytes in a background of chronic active inflammation affecting the ureteral wall. Herein, we describe a case of a 64-year-old man with bladder cancer affecting the left posterolateral wall of the bladder. Radiologically, there was a suspicion of multifocal involvement of the ureteral wall. The patient underwent a radical cystectomy with bilateral pelvic lymphadenectomy and a laparoscopic left nephroureterectomy. Histopathologic examination of the radical cystectomy revealed an invasive high-grade urothelial carcinoma. The wall of the left ureter was replaced by abundant foamy histocytes and a mixed inflammatory infiltrate with lymphocytes and plasma cells consistent with xanthogranulomatous ureteritis. In this report, we highlight the importance of awareness of this benign process when observing a ureteral mass in cancer patients.

A Rare Case of Co-Existing Mucin-Producing Urothelial-Type Adenocarcinoma of the Prostate and Acinar Adenocarcinoma.

Mucin-producing urothelial-type adenocarcinoma of the prostate is an extremely rare neoplasm, and its coexistence with acinar adenocarcinoma is exceptional. A 70-year-old man presented with treatment resistant symptoms of urinary obstruction. The serum prostate specific antigen (PSA) level was normal. Cystoscopy revealed a kind of "cottony fluff" in the prostatic urethra. A computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a polylobulated, hyperintense lesion with mucinous content. It was located in the right lobe of the prostate and measured 35 × 27 × 35 mm. The bladder cavity did not show lesions and the gastrointestinal endoscopy was normal. Thus, the patient underwent a radical cystoprostatectomy. The histological sections showed the characteristics of a mucin-producing adenocarcinoma with extensive areas of mucin pools formation. No areas of necrosis, glandular urethritis, or carcinoma in situ were identified. Neither lymphovascular and perineural invasion nor lymph node metastases were identified. The immunohistochemical study showed diffuse positivity for keratin (KRT) 7, KRT20, and membranous beta-catenin and focal positivity for KRT34betaE12 and caudal-related homeobox gene 2 (CDX2). In addition, we identified a 10-mm focus of prostatic acinar adenocarcinoma that was positive for racemase and NKX3.1. There is no treatment algorithm for this condition; however, surgery (radical prostatectomy) with or without adjuvant chemotherapeutic treatment represents a therapeutic alternative.

[Metastases in the paranasal sinuses secondary to prostatic adenocarcinoma]. / Metástasis en senos paranasales secundaria a adenocarcinoma prostático.

OBJECTIVE: To report a new case of exceptional metastases from a prostatic carcinoma. METHODS: 64-year-old male with nine months history of disseminated prostate cancer, taking hormonal treatment and biphosphonates, who presents with rising PSA, facial dysesthesia and left exophtalmos. MRI recognizes the existence of a solid mass in the right maxillary sinus with involvement of the ipsilateral orbital floor, and another one in the left frontal sinus invading the roof of the ipsilateral orbit and also with orbital extraconal involvement. RESULTS: Once the diagnosis was established hormonal maneuvers were performed and chemotherapy with docetaxel was administered achieving at the start of treatment measurable disease stabilization with biochemical remission of PSA levels, followed posteriorly by progression without changes in the metastatic images. Currently new cytoreductive therapy with docetaxel has been initiated. CONCLUSIONS: 1% of the prostatic tumors involve the head in their evolution. Most frequent metastases are localized in the brain and meninges, being the involvement of paranasal sinuses and ocular orbit extraordinary. The importance of these comes from the extension to the orbit and the eye in vicinity. Second line hormonal maneuvers, local radiotherapy and systemic chemotherapy will be necessary for control, although results are discouraging. In general, prognosis is poor, with short survival.

Metástasis en senos paranasales secundaria a adenocarcinoma prostático / Metastases in the paranasal sinuses secondary to prostatic adenocarcinoma

Objetivo: Presentar un nuevo caso de metástasis excepcional por carcinoma de próstata. Método: Varón de 64 años diagnosticado 9 meses antes de carcinoma prostático diseminado, en tratamiento hormonal además de bifosfonatos, que debuta con elevación de las cifras de PSA, disestesia facial y exoftalmos izquierdo. En RMN se reconoce la existencia de una masa sólida en seno maxilar derecho con afectación del suelo orbitario del mismo lado, y de otra de las mismas características localizada en seno frontal izquierdo con invasión del techo de la órbita homolateral y afectación extraconal orbitaria. Resultados: Una vez establecido el diagnóstico se sometió al paciente a maniobras hormonales y se administró quimioterapia con docetaxel obteniendo una estabilización de la enfermedad mensurable con una remisión bioquímica de los niveles del PSA al principio del tratamiento, para progresar posteriormente, sin observarse cambios en las imágenes metastásicas. En la actualidad se ha iniciado de nuevo terapia citorreductora con docetaxel. Conclusiones: El 1% de los tumores prostáticos afectarán la cabeza en su evolución. Las metástasis más frecuentes se localizan en cerebro y meninges, siendo la afectación de senos paranasales y órbita ocular extraordinaria. La importancia de éstas viene dada por la afectación en vecindad de la órbita y del ojo. Serán precisas para su control las maniobras hormonales de 2ª línea, la radioterapia local y la quimioterapia sistémica, aunque con resultados desalentadores. En general el pronóstico es malo, con sobrevivas cortas (AU)

Objective: To report a new case of exceptional metastases from a prostatic carcinoma. Methods: 64-year-old male with nine months history of disseminated prostate cancer, taking hormonal treatment and biphosphonates, who presents with rising PSA, facial dysesthesia and left exophtalmos. MRI recognizes the existence of a solid mass in the right maxillary sinus with involvement of the ipsilateral orbital floor, and another one in the left frontal sinus invading the roof of the ipsilateral orbit and also with orbital extraconal involvement. Results: Once the diagnosis was established hormonal maneuvers were performed and chemotherapy with docetaxel was administered achieving at the start of treatment measurable disease stabilization with biochemical remission of PSA levels, followed posteriorly by progression without changes in the metastatic images. Currently new cytoreductive therapy with docetaxel has been initiated. Conclusions: 1% of the prostatic tumors involve the head in their evolution. Most frequent metastases are localized in the brain and meninges, being the involvement of paranasal sinuses and ocular orbit extraordinary. The importance of these comes from the extension to the orbit and the eye in vicinity. Second line hormonal maneuvers, local radiotherapy and systemic chemotherapy will be necessary for control, although results are discouraging. In general, prognosis is poor, with short survival (AU)

[Nephroblastoma or Wilms tumor. Adult presentation. Report of two cases]. / Nefroblastoma o tumor de Wilms. Presentación en adultos. Estudio de dos casos.

OBJECTIVES: To present to new cases of nephroblastoma or Wilms tumor diagnosed in adult age. METHODS: The first case we report is a 16-year-old female with the diagnosis of stage I nephroblastoma after radical nephrectomy for a right renal mass. She underwent systemic polychemotherapy. The second case is a 33-year-old female with the diagnosis of nephroblastoma after percutaneous biopsy of a right renal mass. Due to the presence of lymph node, hepatic and lung dissemination systemic polychemotherapy (ACTD-VCR-DOX) was given. Right nephrectomy with regional lymph node dissection and hepatic metastasis excision were performed after confirmation of mass reduction. After that, the patient continued receiving systemic polychemotherapy with the same drugs. After resection of a lung nodule which did not disappear, and after confirmation of tumoral presence CB and VP 16 were added. RESULTS: Both patients are disease-free after 58 and 46 months respectively. CONCLUSIONS: This type of tumor typical of childhood is extremely rare in adult age, and despite worse survivals and more aggressiveness are described, they may be treated with the same protocols used in children, following any of the two big co-operative groups: American NWTS or European SIOP.

Nefroblastoma o tumor de Wilms. Presentación en adultos. Estudio de dos casos / Nephroblastoma or Wilms tumor. Adult presentation. Report of two cases

Objetivo: Presentar dos nuevos casos de nefroblastoma o tumor de Wilms diagnosticados en la edad adulta. Métodos: El 1º caso que presentamos corresponde a una mujer de 16 años, a la que tras la nefrectomía radical por masa sólida dcha se diagnostica de nefroblastoma, en estadío I, sometiéndola posteriormente a poliquimioterapia sistémica. El 2º caso corresponde también a una mujer de 33 años diagnosticada mediante biopsia percutánea de masa renal sólida de nefroblastoma derecho. A consecuencia de la diseminación ganglionar, hepática y pulmonar que presentaba, se le ofreció poliquimioterapia sistémica (ACTD-VCR-DOX), tras lo cual, y habiendo evidenciado reducción de la masa se sometió a nefrectomía derecha, linfadenectomía regional y metastasectomía hepática. Posteriormente se continuó con poliquimioterapia sistémica con los mismos productos. Tras tener que resecar un nódulo pulmonar que no desapareció, y habiendo constatando presencia tumoral se añadió CB y VP16. Resultados: Ambas pacientes se encuentran, tras 58 y 46 meses respectivamente, libres de enfermedad. Conclusiones: En la edad adulta, este tipo de tumor propio de la infancia, es extremadamente raro, y aunque estén descritas peores supervivencias y mayor agresividad, puede y debe tratarse con iguales protocolos que los empleados en la infancia, siguiendo a cualquiera de los dos grandes grupos cooperativos existentes, el NWTS americano y el SIOP europeo (AU)

Objectives: To present to new cases of nephroblastoma or Wilms tumor diagnosed in adult age. Methods: The first case we report is a 16-year-old female with the diagnosis of stage I nephroblastoma after radical nephrectomy for a right renal mass. She underwent systemic polychemotherapy. The second case is a 33-year-old female with the diagnosis of nephroblastoma after percutaneous biopsy of a right renal mass. Due to the presence of lymph node, hepatic and lung dissemination systemic polychemotherapy (ACTD-VCR-DOX) was given. Right nephrectomy with regional lymph node dissection and hepatic metastasis excision were performed after confirmation of mass reduction. After that, the patient continued receiving systemic polychemotherapy with the same drugs. After resection of a lung nodule which did not disappear, and after confirmation of tumoral presence CB and VP 16 were added. Results: Both patients are disease-free after 58 and 46 months respectively. Conclusions: This type of tumor typical of childhood is extremely rare in adult age, and despite worse survivals and more aggressiveness are described, they may be treated with the same protocols used in children, following any of the two big co-operative groups: American NWTS or European SIOP (AU)

[Penile fracture with associated urethral rupture]. / Fractura de pene con rotura asociada de uretra.

OBJECTIVE: We report two cases of penile fracture; one case with associated rupture of the corpus spongiosum and complete urethral section, and the other presenting a second cavernous fracture three years after a first episode. METHODS: The first patient, 32-years-old, suffered the fracture of the right corpus cavernosum during intercourse three years after a first fracture requiring surgical repair. This time he also underwent surgery immediately to find and repair the lesion, with good functional outcome. The second patient, 29-years-old, suffered a transverse fracture at the bases of both corpora cavernosa associated with complete section of the urethra. He underwent emergency surgery to repair all lesions with good esthetic and functional results. RESULTS: Traumatic lesions of the penis with fracture of the corpora cavernosa are rare and the association with urethral rupture is exceptional, as well as it is the possibility of second fracture years ofter a first episode. CONCLUSIONS: Penile fracture is a rare reason for consultation in the emergency setting, which should be repaired immediately with evacuation of the hematoma, closure of the albuginea's lesion and repair of the urethral lesions when they appear. Results are better, avoiding mid and long-term complications.

Fractura de pene con rotura asociada de uretra / Penile fracture with associated urethral rupture

OBJETIVO: Presentamos dos casos de fractura de pene, 1 con fractura asociada de cuerpo esponjoso y sección completa de uretra y otro que sufrió la segunda fractura cavernosa 3 años después de la primera. MÉTODOS: El primer paciente, de 32 años, sufrió la fractura del cuerpo cavernoso derecho durante el coito, 3 años después de haber sufrido una primera fractura de la que fue intervenido de urgencia. En este caso también fue intervenido de inmediato evidenciando la lesión y reparándola, con buenos resultados funcionales. El segundo paciente, de 29 años, sufrió la fractura transversal de ambos cuerpos cavernosos a nivel basal asociándose la sección completa de la uretra en una misma línea de fractura. Intervenido de urgencia se solucionaron todas las lesiones, con buenos resultados estéticos y funcionales. RESULTADOS: Dentro de la rareza que supone la lesión peneana traumática con fractura cavernosa, la asociación de lesión uretral supone una excepción, así como la posibilidad de sufrir una segunda fractura años después de la primera. CONCLUSIONES: La fractura peneana supone una rara urgencia que debe ser reparada de forma inmediata evacuando el hematoma, suturando la lesión albugínea y solucionando la lesión uretral en los raros casos en que se asocie. Los resultados serán mejores, evitándose complicaciones a medio y largo plazo

OBJECTIVE: We report two cases of penile fracture; one case with associated rupture of the corpus spongiosum and complete urethral section, and the other presenting a second cavernous fracture three years after a first episode. METHODS: The first patient, 32 years old, suffered the fracture of the right corpus cavernosum during intercourse three years after a first fracture requiring surgical repair. This time he also underwent surgery immediately to find and repair the lesion, with good functional outcome. The second patient,29 years old, suffered a transverse fracture at the bases of both corpora cavernosa associated with complete section of the urethra. He underwent emergency surgery to repair all lesions with good esthetic and functional results. RESULTS: Traumatic lesions of the penis with fracture of the corpora cavernosa are rare and the association with urethral rupture is exceptional, as well as it is the possibility of second fracture years after a first episode. CONCLUSIONS: Penile fracture is a rare reason for consultation in the emergency setting, which should be repaired immediately with evacuation of the hematoma, closure of the albuginea’s lesion and repair of the urethral lesions when they appear. Results are better, avoiding mid and long-term complications

Infección por HTLV post-trasplante renal / HTLV infection after renal transplant

OBJECTIVOS: Presentamos los 2 primeros casos de infección por HTLV-I tras trasplante renal ocurridosen nuestro país y su evolución (1998).MÉTODOS: Se describen los casos de 2 pacientes trasplantadosque han desarrollado una mielopatía subaguda, la Paraparesia Espástica Tropical, secundaria a infección por HTLV-I y se revisa su evolución.RESULTADOS: En ambos casos, en el momento actual, presentan gran incapacidad, siendo, en concreto un paciente,dependiente para la vida diaria.CONCLUSIONES: Creemos necesaria la detección de HTLV-I, en todos los donantes, mediante técnicas indirectas(enzimoinmunoensayo, ELISA) o directas (PCR) dada la evolución tórpida de la infección en el paciente trasplantadopor un lado y por otro, por la creciente población inmigrante en nuestro país que conlleva un aumento de portadores asintomáticos del virus

OBJECTIVES: We report the first two cases of HTLV-1 infection after a renal transplant appearing in our country and their outcomes. ;;METHODS: We describe the cases of two transplant patients who developed subacute myelopathy, known as Tropical Spastic Paraparesis, secondary to HTLV-I infection and ;;review their evolution. ;;RESULTS: Both cases show a great disability today, being one of them dependent for his daily life. ;;CONCLUSIONS: We believe that HTLV-I detection is ;;necessary in all donors by indirect (ELISA) or direct (PCR) techniques due to its symptomless evolution in the transplant patient on the one hand, and the growing immigrant ;;population in our country which associates an increase in the number of asymptomatic carriers of the virus

[HTLV infection after renal transplant]. / Infección por HTLV post-trasplante renal.

OBJECTIVES: We report the first two cases of HTLV-1 infection after a renal transplant appearing in our country and their outcomes. METHODS: We describe the cases of two transplant patients who developed subacute myelopathy, known as Tropical Spastic Paraparesis, secondary to HTLV-1 infection and review their evolution. RESULTS: Both cases show a great disability today, being one of them dependent for his daily life. CONCLUSIONS: We believe that HTLV-1 detection is necessary in all donors by indirect (ELISA) or direct (PCR) techniques due to its symptomless evolution in the transplant patient on the one hand, and the growing immigrant population in our country which associates an increase in the number of asymptomatic carriers of the virus.

[Paratesticular leiomyosarcoma. Review and update]. / Leiomiosarcoma paratesticular. Revisión y puesta al día.

OBJECTIVES: To present one case of paratesticular leiomyosarcoma, a rare tumor which has been reported in 5 cases only in our country. To review the management of this type of tumor. METHODS: A 73-year-old male presenting with a 4 cm mass adjacent to the right testicle underwent excision of the mass, spermatic cord and testicle through an inguinal approach. RESULTS: The tumor was classified as a grade 3 leiomyosarcoma, with positive immunohistochemical staining for desmin and smooth muscle actin. After this pathology report we did not consider adjuvant oncological treatment. Tumor relapse has not appeared so far. CONCLUSIONS: Radical surgery is the only feasible and successful treatment for paratesticular sarcomas, with the exception of rabdomyosarcoma, because they are radio and chemoresistant. The inguinal approach is the ideal and obligatory one, including excision of the spermatic cord and adjacent testicle. Long-term periodic follow-up visits are mandatory because relapses may occur even long time after diagnosis. In case of relapse, surgery is again the only tool we have to control this type of tumor. Currently radiotherapy is recommended in cases of local recurrence after surgery. 5-year survival rates are around 75%, and 10-year 50%.

[Adrenal spindle cell angiosarcoma. Report one case]. / Angiosarcoma suprarrenal de células fusiformes. A propósito de un caso.

OBJECTIVES: To report a new case of spindle cell angiosarcoma of the adrenal gland. METHODS: We reviewed 22 cases previously published of this rare entity, analyzing at the same time both clinical and pathologic findings of this infrequent sarcoma of urological localization. The epithelioid variety is the most common, which makes our spindle cell type case rarer, if possible. RESULTS: 59-year-old male without significant previous medical history presenting at the emergency department with sudden onset of pain in the left hemithorax after several months of discomfort in the area. Diagnostic imaging tests showed a heterogeneous mass dependent of the left kidney. After performing radical nephrectomy and adrenalectomy, pathologic and immunohistochemical studies offered the diagnosis. CONCLUSIONS: Despite the rarity of these tumors it should be taken into consideration in the differential diagnosis of every adrenal tumor. Complete surgical excision is the treatment of choice, adding systemic chemotherapy as adjuvant therapy; radiotherapy is reserved as a second line after excision of recurrences if there are.