Pólipo fibroepitelial de uretra anterior / Fibroepithelial polyp of the anterior urethra

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Metástasis cutánea de carcinoma urotelial de vejiga. Presentación de un caso / Cutaneous metastasis of urothelial carcinoma of the bladder. Case report

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Supramesocolic access to the left renal pedicle: anatomical and surgical description.

OBJECTIVE: To expose and remind the supamesocolic approach to the left renal pedicle, in addition to review its main indications. METHODS/RESULTS: We perform a detailed description of the surgical technique showing its indications, the position, the incision and retraction systems employed, detailing the steps followed during dissection. CONCLUSIONS: Adequate vascular control and complete resection of large renal and adrenal masses require an adequate exposition; the knowledge of surgical techniques such as supramesocolic approach to the left renal pedicle is very useful and may ease the course of retroperitoneal operations avoiding complications and giving comfort in a frequently difficult operation.

La vía supramesocólica de acceso al pedículo renal izquierdo: descripción de anatomía quirúrgica / Supramesocolic approach to the left renal pedicle: Description of the surgical anatomy

OBJETIVO: Exponer y recordar la vía de acceso supramesocólica al pedículo renal izquierdo, además de recordar las principales indicaciones de la misma. MÉTODO/RESULTADOS: Realizamos una descripción detallada de la técnica quirúrgica exponiendo sus indicaciones, la posición, incisión y sistemas de retracción utilizados y detallando los pasos llevados a cabo durante la disección. CONCLUSIÓN: El adecuado control vascular y la resección completa de grandes masas renales y suprarrenales precisan de una adecuada exposición; por lo que el conocimiento de técnicas quirúrgicas como el acceso supramesocólico al pedículo renal izquierdo es de gran utilidad y que puede facilitar el curso de cirugías retroperitoneales evitando complicaciones y aportando comodidad a actuaciones con frecuencia comprometidas

OBJECTIVE: To expose and remind the supamesocolic approach to the left renal pedicle, in addition to review its main indications. METHODS/RESULTS: We perform a detailed description of the surgical technique showing its indications, the position, the incision and retraction systems employed, detailing the steps followed during dissection. CONCLUSIONS: Adequate vascular control and complete resection of large renal and adrenal masses require an adequate exposition; the knowledge of surgical techniques such as supramesocolic approach to the left renal pedicle is very useful and may ease the course of retroperitoneal operations avoiding complications and giving comfort in a frequently difficult operation

Angiomiolipoma de gran tamaño en polo superior de riñón derecho / Giant angiomyolipoma in the upper pole of the right kidney

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Tubulocystic renal carcinoma (low grade collecting duct carcinoma).

OBJECTIVE: To report a case of tubulocystic renal carcinoma diagnosed in an adult, after a work up study for hematuria. METHODS/RESULTS: 59-year-old male, CT scan was performed during a study for self-limited hematuria showing a 4.2 cm solid mass with areas suspicious of pseudocystic malignancy. Due to its debut with hematuria and renal sinus involvement laparoscopic radical nephrectomy was performed, establishing the diagnosis of tubulocystic carcinoma (low grade collecting duct carcinoma). CONCLUSION: Tubulocystic carcinoma presents histological characteristics and a natural history that makes it different from the classic type of Bellini duct carcinoma, the latter being a rapidly growing tumor with poor prognosis which is usually diagnosed in advanced stages.

Carcinoma renal túbulo-quístico / Tubulocystic renal carcinoma (low grade collecting duct carcinoma)

OBJETIVO: Presentar el caso clínico de un carcinoma renal túbulo-quístico diagnosticado, en un adulto, tras estudio por hematuria. MÉTODO/RESULTADO: Varón de 59 años que durante un estudio por hematuria franca autolimitada se realizó un TAC que mostró una tumoración de 4,2 cm sólida con áreas pseudoquísticas sospechosa de malignidad. Debido al debut por hematuria y a la afectación del seno renal se realizó nefrectomía radical laparoscópica, estableciendo el diagnóstico de carcinoma túbulo-quístico (carcinoma de los ductos colectores de bajo grado). CONCLUSIÓN: El carcinoma túbulo-quístico presenta unas características tanto histológicas como de historia natural de la enfermedad que lo diferencia de la variante clásica del carcinoma de los ductos colectores de Bellini, siendo éste último un tumor de rápido crecimiento y mal pronóstico que suele diagnosticarse en estadios avanzados(AU)

OBJECTIVE: To report a case of tubulocystic renal carcinoma diagnosed in an adult, after a work up study for hematuria. METHODS/RESULTS: 59-year-old male, CT scan was performed during a study for self-limited hematuria showing a 4.2 cm solid mass with areas suspicious of pseudocystic malignancy. Due to its debut with hematuria and renal sinus involvement laparoscopic radical nephrectomy was performed, establishing the diagnosis of tubulocystic carcinoma (low grade collecting duct carcinoma). CONCLUSION: Tubulocystic carcinoma presents histological characteristics and a natural history that makes it different from the classic type of Bellini duct carcinoma, the latter being a rapidly growing tumor with poor prognosis which is usually diagnosed in advanced stages

Supernumerary testicle: case report and bibliographic review.

OBJECTIVE: We report a case of supernumerary testis, a rare anomaly with only around 100 cases reported in the literature. METHODS: We describe the case of a 26-year-old man who consulted for a left paratesticular tumor. Physical examination and ultrasound showed a 2-cm nodular lesion over the left epididymis. The lesion was confirmed as supernumerary testis by surgical examination and biopsy and was subsequently excised, given the malignancy potential. RESULTS: The supernumerary testis was evaluated using two standard classifications, one assessing function and embryological development, and the other assessing topography, anatomy, and reproductive potential. CONCLUSIONS: The differential diagnosis for an intrascrotal mass should include the possibility of a supernumerary testis; hence, surgical examination and biopsy are necessary. Supernumerary testes should be excised in the case of pain, dysplasia, or in situ carcinoma, or whenever the biopsy is inconclusive.

Poliorquia: presentación de un caso y revisión de la literatura / Supernumerary testicle: case report and bibliographic review

OBJETIVO: Presentar un caso de teste supernumerario, rara anomalía de la que existen descritos y fundamentados aproximadamente 120 casos. MÉTODOS: Presentamos el caso de un varón de 26 años que consultó por presentar tumoración paratesticular izquierda. La exploración física y ecográfica evidenciaron una lesión nodular de aproximadamente 2 cm sobre epidídimo izquierdo que se confirmaría posteriormente durante la exploración quirúrgica y biopsia. Dada la posibilidad de malignización se decidió extirpar el teste supernumerario. RESULTADOS: Para evaluar un teste supernumerario disponemos de varias clasificaciones que evalúan la funcionalidad y el desarrollo embriológico del mismo, así como la topografía, la anatomía y su potencial reproductivo. CONCLUSIONES: Ante una masa intraescrotal debemos tener en cuenta a la hora de realizar el diagnóstico diferencial la presencia de un teste supernumerario, siendo fundamental la exploración quirúrgica y biopsia. Realizaremos exéresis del teste supernumerario siempre que sea origen de dolor, displasia, carcinoma in situ, o la biopsia arroje dudas(AU)

OBJECTIVE: We report a case of supernumerary testis, a rare anomaly with only around 100 cases reported in the literature. METHODS: We describe the case of a 26-year-old man who consulted for a left paratesticular tumor. Physical examination and ultrasound showed a 2-cm nodular lesion over the left epididymis. The lesion was confirmed as supernumerary testis by surgical examination and biopsy and was subsequently excised, given the malignancy potential. RESULTS: The supernumerary testis was evaluated using two standard classifications, one assessing function and embryological development, and the other assessing topography, anatomy, and reproductive potential. CONCLUSIONS: The differential diagnosis for an intrascrotal mass should include the possibility of a supernumerary testis; hence, surgical examination and biopsy are necessary. Supernumerary testes should be excised in the case of pain, dysplasia, or in situ carcinoma, or whenever the biopsy is inconclusive(AU)

Neuroendocrine carcinoma of the urinary bladder. 15-year retrospective analysis.

OBJECTIVES: Neuroendocrine tumors (NET) are cancers found in the bronchopulmonary tract, where they were first described in 1926. The tumors are associated with poor prognosis due to their high metastatic potency even after radical treatments associated with other neo- or adjuvant therapies. NET of the urinary bladder is a rare tumor and accounts for 0.5% of bladder tumors. METHODS: The study was designed as an observational, descriptive and retrospective study of 13 patients diagnosed, treated, and followed for NET of the urinary bladder at the Hospital and University Complex of Albacete, Albacete, Spain between 1995 and 2010. RESULTS: The sample was composed of 11 men and 2 women. Mean patient age at the time of diagnosis was 71 (range, 57-88; SD, 6.98) years. T4 (6 patients) was the most common T tumor stage, followed by T2 (5 patients) and T3 (2 patients). In the case of N tumor stage, the most common was N2. In the remaining 3 patients, the degree of lymph node involvement could not be assessed. Six presented distant metastasis at the time of diagnosis. Eleven patients presented small-cell NET on histology. Seven underwent radical surgery (radical cystectomy). All other patients were treated by deep transurethral resection of bladder tumor, except for 1 patient treated by partial cystectomy. Adjuvant chemo-therapy (usually an association of carboplatin/cisplatin and etoposide) was administered to 4 patients. Of these 4 patients, 2 were also treated by pelvic radiotherapy. Two patients survived more than 5 years following diagnosis. In fact, at the time the study data was collected only 4 patients had survived and 2 presented tumor recurrence. Of the 9 deaths, 8 occurred within 6 months of diagnosis and 1 at 24 months. All of them were the result of the disease itself. CONCLUSIONS: Neuroendocrine tumor of the urinary bladder is a rare, aggressive tumor with high metastatic potential that should be considered in the differential diagnosis of urinary bladder neoplasms. Despite various multimodality treatments have been used prognosis is poor.

Carcinoma neuroendocrino de vejiga. Analisis retrospectivo de 15 años / Neuroendocrine carcinoma of the urinary bladder. 15-year retrospective analysis

OBJETIVO: Los tumores neuroendocrinos (TNE) son tumores propios del árbol broncopulmonar, donde fueron descritos por primera vez en 1926. Son tumores de mal pronóstico debido a su gran poder metastásico aun después de tratamientos radicales asociados a otras terapias neo o adyuvantes. El TNE de vejiga representa el 0,5% de los tumores vesicales. MÉTODOS: Estudio observacional, descriptivo y retrospectivo de 13 pacientes diagnosticados, tratados y controlados por carcinoma neuroendocrino de vejiga en el Complejo Hospitalario Universitario de Albacete por el periodo entre los años 1995 y 2010. RESULTADOS: La muestra estaba formada por 11 hombres y 2 mujeres. La edad media fue de 71 años. El estadio tumoral T más frecuente hallado fue T4. El estadio tumoral N más frecuente hallado fue N2 . Seis pacientes presentaron metástasis a distancia en el momento del diagnóstico. Once pacientes presentaron histológicamente TNE de células pequeñas. A 7 pacientes se les realizó cirugía radical (cistectomía radical). La quimioterapia adyuvante se administró a 4 pacientes basada principalmente en la asociación de carboplatino/cisplatino y etopósido. A 2 de estos 4 pacientes se les administró radioterapia pélvica complementaria. La Mediana de supervivencia hallada fue de 5,1 meses. Dos pacientes presentaron supervivencia por encima de 5 años tras el diagnóstico. De los 9 éxitus letalis acontecidos, 8 de ellos se produjeron en los primeros 6 meses después del diagnóstico. El caso restante falleció a los 24 meses. Todas estas muertes fueron debidas a la propia enfermedad. CONCLUSIONES: El carcinoma neuroendocrino de vejiga es un tumor infrecuente, agresivo y con alto potencial metastásico que debe ser tenido en cuenta a la hora de realizar el diagnóstico diferencial en las neoplasias de vejiga. A pesar de utilizar distintos tratamientos multimodales el pronóstico es infausto(AU)

OBJECTIVES: Neuroendocrine tumors (NET) are cancers found in the bronchopulmonary tract, where they were first described in 1926. The tumors are associated with poor prognosis due to their high metastatic potency even after radical treatments associated with other neo- or adjuvant therapies. NET of the urinary bladder is a rare tumor and accounts for 0.5% of bladder tumors. METHODS: The study was designed as an observational, descriptive and retrospective study of 13 patients diagnosed, treated, and followed for NET of the urinary bladder at the Hospital and University Complex of Albacete, Albacete, Spain between 1995 and 2010. RESULTS: The sample was composed of 11 men and 2 women. Mean patient age at the time of diagnosis was 71 (range, 57-88; SD, 6.98) years. T4 (6 patients) was the most common T tumor stage, followed by T2 (5 patients) and T3 (2 patients). In the case of N tumor stage, the most common was N2. In the remaining 3 patients, the degree of lymph node involvement could not be assessed. Six presented distant metastasis at the time of diagnosis. Eleven patients presented small-cell NET on histology. Seven underwent radical surgery (radical cystectomy). All other patients were treated by deep transurethral resection of bladder tumor, except for 1 patient treated by partial cystectomy. Adjuvant chemo-therapy (usually an association of carboplatin/cisplatin and etoposide) was administered to 4 patients. Of these 4 patients, 2 were also treated by pelvic radiotherapy. Two patients survived more than 5 years following diagnosis. In fact, at the time the study data was collected only 4 patients had survived and 2 presented tumor recurrence. Of the 9 deaths, 8 occurred within 6 months of diagnosis and 1 at 24 months. All of them were the result of the disease itself(AU)

Vaginal metastasis of a clear renal cell carcinoma.

OBJECTIVE: Remember that kidney cancer is a disease whose incidence is increasing due to increased use of additional imaging tests, which is changing the way of diagnosis, making the classic clinical syndrome synonymous with advanced illness. METHODS: We report the case of a patient with a right renal tumor with renal vein involvement that in the natural course of the disease showed a vaginal metastasis of clear renal cell carcinoma, which was treated with surgical excision. RESULTS: This case is a clear example of how unpredictable is the clinical evolution of this disease and how little we know about the way of dissemination. CONCLUSIONS: Local excision, with or without radiotherapy, or radiotherapy alone are recommended in cases of unique metastasis after nephrectomy.

Metástasis en vagina de tumor renal de células claras / Vaginal metástasis of a clear renal cell carcinoma

OBJETIVO: Recordar que el cáncer renal es una enfermedad cuya incidencia está en aumento debido al mayor uso de pruebas complementarias, lo cual está modificando el modo de diagnóstico, convirtiendo a la clínica clásica en sinónimo de enfermedad avanzada.MÉTODO: Presentamos un caso clínico de una paciente con un tumor renal derecho con afectación de la vena renal intervenido, que en la evolución natural de la enfermedad presentó metástasis vaginal del tumor de células claras; las cuales fueron tratadas con exéresis quirúrgica. RESULTADO: Este caso es un claro ejemplo de lo poco previsible de la evolución clínica y de lo poco esclarecido que está el modo de diseminación de esta enfermedad.CONCLUSIÓN: La excisión local, asociada o no de radioterapia, o la radioterapia sola son las terapias aconsejadas en los casos de aparición de metátasis únicas tras la nefrectomía(AU)

OBJECTIVE: Remember that kidney cancer is a disease whose incidence is increasing due to increased use of additional imaging tests, which is changing the way of diagnosis, making the classic clinical syndrome synonymous with advanced illness.METHODS: We report the case of a patient with a right renal tumor with renal vein involvement that in the natural course of the disease showed a vaginal metastasis of clear renal cell carcinoma, which was treated with surgical excision.RESULTS: This case is a clear example of how unpredictable is the clinical evolution of this disease and how little we know about the way of dissemination.CONCLUSIONS: Local excision, with or without radiotherapy, or radiotherapy alone are recommended in cases of unique metastasis after nephrectomy(AU)

Avulsión genital / Genital avulsion

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Gran litiasis neovesical por migración de esfínter urinario artificial / Large neobladder lithiasis secondary to artificial urinary Sphincter migration

No disponible