[Tissue biomarkers in prostate cancer.] / Biomarcadores tisulares en cáncer de próstata.

INTRODUCTION: Prostate cancer is themost prevalent and deadliest neoplasm in men, with adiverse clinical presentantion and oncological outcomes.The diagnosis and treatment remains a challenge.New essays about biomarkers show their potential asa tool that may influence in clinical decision making,risk stratification and management of the disease. METHODS: we performed a literature review abouttissue biomarkers in the diagnosis and treatment ofprostate cancer. RESULTS: Within the last years, a wide number ofdiagnostic and prognostic tests in tissue have been developed(ConfirmMDx, Promark, Oncoytype DX, Decipher),creating an opportunity to improve the diagnosis,prognosis and treatment of prostate cancer. CONCLUSIONS: Since prostate cancer is the mostprevalent neoplasm in men, it is mandatory to stratifypatients correctly to prevent unnecessary biopsiesand overtreatment in low risk patients, as well as designthe best strategy in those with high risk disease.Tissue biomarkers may become a useful tool in precisionmedicine to guide decision making.

INTRODUCCIÓN: El cáncer de próstataes el cáncer no cutáneo más prevalente en los hombresy la principal causa de muerte relacionada con tumoren varones. Es una neoplasia maligna con una presentaciónclínica y resultados oncológicos muy variables.El diagnóstico y el tratamiento siguen siendo un desafíoy, en ocasiones, se vuelven muy controvertidos. Losnuevos ensayos de biomarcadores se han mostradoprometedores como una herramienta complementariapara ayudar en la toma de decisiones, en la estratificacióndel riesgo y en el manejo de la enfermedad.MÉTODOS: Revisamos la literatura actual sobre eluso de biomarcadores tisulares en las decisiones dediagnóstico y tratamiento en el cáncer de próstata.RESULTADOS: En los últimos años han surgido unaamplia gama de pruebas de diagnóstico y pronósticodel cáncer de próstata en tejido tumoral (ConfirmMDx,Promark, Oncoytype DX, Decipher). El desarrollo deestos métodos ha creado nuevas oportunidades paramejorar el diagnóstico, el pronóstico y las decisionesde tratamiento del cáncer de próstata. CONCLUSIONES: Dado que el cáncer de próstata esuno de los tumores más prevalentes en los varones yen nuestro medio, es deseable estratificar adecuadamenteel riesgo de los pacientes para evitar biopsias innecesarias y sobretratamiento en pacientes de bajoriesgo y guiar estrategias de tratamiento adecuadas enpacientes de alto riesgo. Los biomarcadores tisularespueden resultar en herramientas complementariasútiles de la medicina de precisión para ayudar en latoma de decisiones compartida y para dirigir las decisionesde tratamiento.

[Renal cell carcinoma with (tubule) papillary architecture. Report of three cases and bibliographic review.] / Carcinoma de células renales con arquitectura (túbulo) papilar. Presentación de tres casos y revisión de la literatura.

OBJECTIVE: Update of clear cell (tubulo) papillary renal cell carcinoma. METHODS: We provide the only three cases described to date in our hospital. RESULTS: One of the new entities of epithelial renal tumors incorporated by the International Society of Urological Pathology (ISUP) in 2013 was the clear cell (tubulo) papillary renal cell carcinoma (RCCtpcc). Although initially was described under other nomenclatures, it was not until 2013 that it was clearly defined. CONCLUSION: The RCCtpcc is usually a low grade and stage subtype of epithelial RCC. It predominates in the sixth decade of life, although cases have already been described in children and young adults. It has a typical immunohistochemical pattern with positive CK7, vimentine, VT and smooth muscle antigen, and negative CD10. They usually have a low malignant potential.

OBJETIVO: Puesta al día del CCR túbulo papilar de células claras. MÉTODO: Aportamos los únicos tres casos descritos hasta la actualidad en nuestro hospital. RESULTADO: Una de las nuevas entidades de tumores renales epiteliales incorporadas por la International Society of Urological Pathology (ISUP) en el año 2013 es el carcinoma de células renales (tubulo) papilar de células claras (CCRtp). Aunque en un principio fue descrito bajo otras nomenclaturas, no es hasta esa fecha cuando se recogen las características que lo definen. CONCLUSIONES: El CCRtp es un subtipo de CCR epitelial, por lo general de bajo grado y estadio. Predomina en la sexta década, aunque ya están descritos casos en niños y adultos jóvenes. Su patrón inmuno-histoquímico característico es: CK7 positivo; CD10 negativo, Vimentina positivo, VT positivo y Antígeno músculo liso positivo. Por lo general son de bajo potencial maligno.

Carcinoma de células renales con arquitectura (túbulo) papilar. Presentación de tres casos y revisión de la literatura / Renal cell carcinoma with (tubule) papillary architecture. Report of three cases and bibliographic review

Objetivo: Puesta al día del CCR túbulo papilar de células claras. Método: Aportamos los únicos tres casos descritos hasta la actualidad en nuestro hospital. Resultado: Una de las nuevas entidades de tumores renales epiteliales incorporadas por la International Society of Urological Pathology (ISUP) en el año 2013 es el carcinoma de células renales (tubulo) papilar de células claras (CCRtp). Aunque en un principio fue descrito bajo otras nomenclaturas, no es hasta esa fecha cuando se recogen las características que lo definen. Conclusiones: El CCRtp es un subtipo de CCR epitelial, por lo general de bajo grado y estadio. Predomina en la sexta década, aunque ya están descritos casos en niños y adultos jóvenes. Su patrón inmuno-histoquímico característico es: CK7 positivo; CD10 negativo, Vimentina positivo, VT positivo y Antígeno músculo liso positivo. Por lo general son de bajo potencial maligno

Objective: Update of clear cell (tubulo) papillary renal cell carcinoma. Methods: We provide the only three cases described to date in our hospital. Results: One of the new entities of epithelial renal tumors incorporated by the International Society of Urological Pathology (ISUP) in 2013 was the clear cell (tubulo) papillary renal cell carcinoma (RCCtpcc). Although initially was described under other nomenclatures, it was not until 2013 that it was clearly defined. Conclusion: The RCCtpcc is usually a low grade and stage subtype of epithelial RCC. It predominates in the sixth decade of life, although cases have already been described in children and young adults. It has a typical immunohistochemical pattern with positive CK7, vimentine, VT and smooth muscle antigen, and negative CD10. They usually have a low malignant potential

[Usefulness of cold ureteral biopsy during radical cystectomy as a predictor of recurrence risk: Review of our series.] / Utilidad de la biopsia fría ureteral durante la cistectomía radical como predictor de riesgo de recidiva: revisión de nuestra serie.

OBJECTIVES: To evaluate the association of positive margins in the intraoperative biopsy during radical cystectomy (RC) with the risk of recurrence in the uretero-ileal anastomosis or upper urinary tract (UUT), and identify potential risk factors for positive ureteral margins. METHODS: A retrospective, descriptive study was performed in patients treated with radical cystectomy due to transitional cell carcinoma (TCC), who underwent a cold biopsy of the ureteral margin at the time of cystectomy. A descriptive analysis and frequency distribution was performed. Fisher's test was used to calculate sensitivity and specificity and a survival analysis was performed. RESULTS: 230 patients were included. Prior to RC, transurethral resection of the bladder tumor and a CT scan were done. The percentage of positive margins was 4.81% for the right ureter and 4.27% for the left. Recurrence was detected in the anastomosis in 2.64% of the cases. In a 0.88% recurrence was found in the UUT (2 cases) at the level of left renal pelvis (1 case) and left kidney (1 case). In the multivariate analysis, neither recurrence in the anastomosis (p=1) or at the UUT (p=1) level during follow-up were significantly associated with the presence of positive margins. An association was found between the pathological biopsy of the right ureter and carcinoma in situ (CIS) of the bladder wall with UUT involvement. We found only association between the cold biopsy of the left ureter and tumor in left UTT. Reimplantation with positive margins was not statistically associated with neither ureteroileal anastomosis or UTT relapse. A relationship was found between the cold biopsy of both ureters and the definitive pathology. CONCLUSIONS: In our study, the presence of positive ureteral margins was not associated with an increased risk of recurrence in the anastomosis or UUT. Although it remains a topic for debate, a strategy to follow may be to adapt ureteral cold biopsies to individual risk, thus perform it in patients with bladder CIS.

Utilidad de la biopsia fría ureteral durante la cistectomía radical como predictor de riesgo de recidiva: revisión de nuestra serie / Usefulness of cold ureteral biopsy during radical cystectomy as a predictor of recurrence risk: Review of our series

OBJETIVOS: Evaluar la asociación de márgenes positivos en la biopsia intra-operatoria al tiempo de la cistectomía radical (CR) con el riesgo de recidiva en la anastomosis urétero-ileal o a nivel del tracto urinario superior (TUS), y estudiar posibles factores de riesgo preoperatorios asociados con el margen ureteral positivo. MÉTODO: Estudio descriptivo retrospectivo de pacientes tratados mediante CR debido a carcinoma de células transicionales (CCT), a los que se les realizó al tiempo de la CR una biopsia fría del margen ureteral. Se realizó un análisis descriptivo y distribuciones de frecuencias. Se empleó el test de Fisher, se calcularon los valores de sensibilidad (Se) y especificidad (Sp) de la prueba, y se realizó un análisis de supervivencia. RESULTADOS: Se incluyeron 230 pacientes que fueron sometidos a CR. Previamente a la CR se les realizó resección transuretral (RTU) de vejiga y tomografía axial computarizada (TC). El porcentaje de márgenes positivos fue de 4,8% para el uréter derecho y de 4,7% para el izquierdo. Se detectó recidiva en la anastomosis en el 2,6% de los casos. En un 0,8% se encontró recidiva en el TUS (2 casos) a nivel de pelvis renal izquierda (1 caso) y riñón izquierdo (1 caso). En el análisis multivariante, ni la recidiva en la anastomosis (p=1) ni a nivel del TUS (p=1) a lo largo del seguimiento, se asociaron de forma significativa con la presencia de márgenes positivos. De forma secundaria se estudiaron los posibles factores anatomopatológicos preoperatorios asociados con el riesgo de margen positivo, encontrando asociación entre la anatomía patológica (A-P) intraoperatoria del uréter derecho y CIS en la RTU vesical y con tumor del TUS asociado. La reimplantación con margen positivo no se asoció estadísticamente con recidiva en la anastomosis ni con recidiva en el TUS. Hubo relación entre A-P intraoperatoria de ambos uréteres y la definitiva. CONCLUSIONES: En nuestro estudio, la presencia de márgenes ureterales positivos no se asociaron con mayor riesgo de recidiva en la anastomosis o en el TUS. Aunque sigue siendo un tema a debate, una estrategia a seguir puede ser adaptar la biopsia fría ureteral al riesgo individual y realizarla a pacientes con CIS vesical

OBJECTIVES: To evaluate the association of positive margins in the intraoperative biopsy during radical cystectomy (RC) with the risk of recurrence in the uretero-ileal anastomosis or upper urinary tract (UUT), and identify potential risk factors for positive ureteral margins. METHODS: A retrospective, descriptive study was performed in patients treated with radical cystectomy due to transitional cell carcinoma (TCC), who underwent a cold biopsy of the ureteral margin at the time of cystectomy. A descriptive analysis and frequency distribution was performed. Fisher's test was used to calculate sensitivity and specificity and a survival analysis was performed. RESULTS: 230 patients were included. Prior to RC, transurethral resection of the bladder tumor and a CT scan were done. The percentage of positive margins was 4.81% for the right ureter and 4.27% for the left. Recurrence was detected in the anastomosis in 2.64% of the cases. In a 0.88% recurrence was found in the UUT (2 cases) at the level of left renal pelvis (1 case) and left kidney (1 case). In the multivariate analysis, neither recurrence in the anastomosis (p=1) or at the UUT (p=1) level during follow-up were significantly associated with the presence of positive margins. An association was found between the pathological biopsy of the right ureter and carcinoma in situ (CIS) of the bladder wall with UUT involvement. We found only association between the cold biopsy of the left ureter and tumor in left UTT. Reimplantation with positive margins was not statistically associated with neither ureteroileal anastomosis or UTT relapse. A relationship was found between the cold biopsy of both ureters and the definitive pathology. CONCLUSIONS: In our study, the presence of positive ureteral margins was not associated with an increased risk of recurrence in the anastomosis or UUT. Although it remains a topic for debate, a strategy to follow may be to adapt ureteral cold biopsies to individual risk, thus perform it in patients with bladder CIS

Herniación asintomática de uréter izquierdo en conducto inguinal durante maniobra de valsalva en paciente con doble sistema pielo-ureteral izquierdo completo / Asymptomatic left ureter inguinal hernia during valsalva maneuver in a patient with complete left pyelo ureteral system duplication

No disponible

Polyamine-modulated factor-1 methylation predicts Bacillus Calmette-Guérin response in patients with high-grade non-muscle-invasive bladder carcinoma.

BACKGROUND: Bacillus Calmette-Guérin (BCG) is a standard treatment to reduce tumor recurrence and delay progression of high-risk non-muscle-invasive (NMI) bladder tumors. However, it is not clear yet which patients are more likely to respond to BCG. OBJECTIVE: The aim was to evaluate the role of polyamine-modulated factor-1 (PMF-1) methylation in predicting clinical outcome of T1 high-grade (T1HG) bladder tumors treated with BCG. DESIGN, SETTING, AND PARTICIPANTS: In a retrospective design, PMF-1 methylation was analyzed on tumor specimens belonging to 108 patients with T1HG NMI bladder cancer undergoing BCG treatment. Median follow-up was 77 mo (range: 5-235 mo). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: PMF-1 methylation was assessed by methylation-specific polymerase chain reactions. Recurrence, progression into muscle-invasive tumors, and disease-specific survival rates were analyzed using competing risks regression analysis. RESULTS AND LIMITATIONS: Among the 108 patients analyzed, 35 had recurring disease (32.4%), 21 progressed (19.4%), and 16 died of disease (14.8%); 71.3% of tumors had PMF-1 methylation. Univariate analyses using cumulative incidence curves revealed that an unmethylated PMF-1 was significantly associated with increased recurrence (p=0.026), progression (p=0.01), and shorter disease-specific survival (log-rank, p=0.03). Multivariate analyses indicated that among sex, age, focality, tumor size, and concomitant carcinoma in situ, only PMF-1 methylation provided significant hazard ratios (HRs) for recurrence of (HR: 2.032; p=0.042), and progression (HR: 2.910; p=0.020). Limitations of the study include its retrospective design, lymphovascular invasion status not available, short maintenance BCG, and that a second transurethral resection was not performed. CONCLUSIONS: Epigenetic analyses revealed that the methylation status of PMF-1 was associated with the clinical outcome of patients with T1HG tumors undergoing BCG treatment. An unmethylated PMF-1 correlated to recurrence and progression in T1HG disease using univariate and multivariate analyses. Thus, assessing the methylation status of PMF-1 may serve to distinguish patients responding to BCG from those who may require more aggressive therapeutic approaches.

Multicenter validation of cyclin D1, MCM7, TRIM29, and UBE2C as prognostic protein markers in non-muscle-invasive bladder cancer.

Transcripts from the four genes encoding cyclin D1, MCM7, TRIM29, and UBE2C have previously been included in gene expression signatures for outcome prediction in stage Ta/T1 urothelial carcinomas. We investigated the prognostic value of the protein expressions in Ta/T1 urothelial carcinomas patients. We used four different tissue microarrays (TMAs) with a total of 859 Ta/T1 urothelial carcinomas from Danish, Swedish, Spanish, and Taiwanese patient cohorts with long-term follow-up. Protein expression was measured by IHC, and antibody specificity was validated by Western blotting. We found the expression of cyclin D1, MCM7, TRIM29, and UBE2C to be significantly associated with progression to muscle-invasive bladder cancer (log-rank test; P < 0.001) in the Danish training cohort (n = 283). Multivariate Cox regression analysis identified cyclin D1 (P = 0.003), TRIM29 (P = 0.001), and UBE2C (P < 0.001) as independent prognostic markers. The prognostic value of the four proteins was validated in a joint validation cohort from Sweden, Spain, and Taiwan (n = 576). Computer-assisted image analysis of the prognostic markers produced results comparable to those obtained by manual scoring. Finally, a four-protein maximum-likelihood classifier was trained on the Danish training cohort and applied to the validation cohort. The four protein markers may help optimize treatment of patients with Ta/T1 bladder cancer. Additional prospective studies are needed for further validation of their clinical relevance.

Cathepsin E, maspin, Plk1, and survivin are promising prognostic protein markers for progression in non-muscle invasive bladder cancer.

Bladder cancer is a common cancer with particularly high recurrence after transurethral resection. In this study, we investigated the prognostic value of the protein expression of cathepsin E, maspin, polo-like kinase 1 (Plk1), and survivin in patients with stage Ta and T1 urothelial carcinomas. Transcripts from the four genes encoding these proteins were previously included in gene expression signatures for outcome prediction for Ta/T1 bladder cancer. We used three different tissue microarrays with 693 non-muscle invasive urothelial carcinomas from Danish, Swedish, and Spanish patient cohorts with long-term follow-up. Protein expression was measured by immunohistochemistry, and antibody specificity was validated by Western blotting. In the Danish patient cohort, we found the expression of cathepsin E, maspin, Plk1, and survivin to be significantly associated with progression to stage T2 to T4 bladder cancer (for each marker: log-rank test; P < 0.001). Multivariate Cox regression analysis identified cathepsin E (P < 0.001), Plk1 (P = 0.021), maspin (P = 0.001), and survivin (P = 0.001) as independent prognostic markers. Furthermore, maspin, survivin, and cathepsin E expression significantly subgrouped patients already stratified by European Organization for Research and Treatment of Cancer risk scores. Finally, we successfully validated the results in tumors from 410 patients from both Sweden and Spain. We conclude that all four protein markers may have prognostic value in non-muscle invasive bladder cancer for guiding optimal treatment of patients. Additional prospective studies are needed for further validation of the clinical relevance of this marker panel.

miR-143, miR-222, and miR-452 are useful as tumor stratification and noninvasive diagnostic biomarkers for bladder cancer.

Altered microRNA (miRNA) expression may occur early in bladder cancer and may play a role in carcinogenesis and tumor behavior. We evaluated whether alterations in miRNA expression could improve disease stratification and outcome prognosis in bladder tumors and noninvasive diagnosis in urinary samples. miR-143, miR-222, and miR-452 expression levels were analyzed by quantitative RT-PCR (RT-qPCR) in paired urinary and matching tumors and in two independent prospective series of tumors and urinary specimens. Differential expression of miR-143, miR-222, and miR-452 in urine were verified by in situ hybridization in matching tumors. Tumor miRNA expression by RT-qPCR correlated with tumor grade, size, and presence of carcinoma in situ for miR-222, recurrence (miR-222 and miR-143), progression (miR-222 and miR-143), disease-specific survival (miR-222), and overall survival (miR-222). Protein expression patterns of potential miRNA targets, including vascular endothelial growth factor, BCL2, v-erb-b2 erythroblastic leukemia viral oncogene (ERBB) homolog 3, and ERBB4, were evaluated by IHC in tissue arrays containing tumors for which miRNAs were assessed by RT-qPCR. Target expression correlated with expression of their predicted regulatory miRNAs, recurrence (ERBB3), progression (ERBB4), disease-specific survival (ERBB3 and ERBB4), and overall survival (ERBB3 and ERBB4). Furthermore, RT-qPCR of miR-452 (area under the curve, 0.848) and miR-222 (area under the curve, 0.718) in urine provided high accuracies for bladder cancer diagnosis. Thus, bladder tumors were characterized by changes in miRNA expression that could aid in tumor stratification and clinical outcome prognosis, and miRNAs were detected in urinary specimens for noninvasive diagnosis.

Myopodin methylation is associated with clinical outcome in patients with T1G3 bladder cancer.

PURPOSE: Bacillus Calmette-Guerin is standard treatment to decrease tumor recurrence and delay progression of high risk, nonmuscle invasive bladder tumors. However, it is not yet clear which T1G3 cases are more prone to more aggressive clinical behavior or susceptible to respond to bacillus Calmette-Guerin. We evaluated the role of myopodin methylation as a clinical outcome prognosticator and predictive biomarker for the bacillus Calmette-Guerin response in patients with T1G3 bladder tumors. MATERIALS AND METHODS: We analyzed the methylation status of myopodin in tumor specimens from 170 patients with T1G3 bladder cancer, including a subset of 108 who underwent bacillus Calmette-Guerin treatment. Myopodin methylation was assessed by methylation specific polymerase chain reactions. Recurrence, progression to muscle invasive tumors and disease specific overall survival were analyzed using competing risks regression analysis. RESULTS: Of the 170 cases analyzed 72 recurred (42.4%) and 36 progressed (21.2%). A total of 24 patients (14.1%) died of the disease. Univariate and multivariate survival analysis revealed that myopodin methylation was significantly associated with an increased recurrence rate (p = 0.004), progression (p = 0.002) and shorter disease specific overall survival (p = 0.020). In a subset treated with bacillus Calmette-Guerin myopodin methylation was also related to an increased recurrence rate (p = 0.011), progression (p = 0.030) and shorter disease specific overall survival (p = 0.028). CONCLUSIONS: Epigenetic analysis revealed that myopodin methylation was associated with tumor aggressiveness and clinical outcome in patients with T1G3 disease. Myopodin methylation distinguished patients responding to bacillus Calmette-Guerin from those who may require a more aggressive therapeutic approach.

Late recurrence from a renal cell carcinoma: solitary right maxilar mass 17 years after surgery.

OBJECTIVES: To report a new case of late renal cell carcinoma recurrence. METHODS: Renal cell carcinoma represents approximately 3% of all adult malignancies. The most frequent metastatic sites are lung (76%), regional lymph nodes (66%), bone (42%), and liver (41%), and it is the third most common infraclavicular neoplasm to metastasize to head and neck. RESULTS: 73 year-old man with a 1 week history of recurrent epistaxis. He underwent left nephrectomy 17 years before due to a renal mass of 8.5 cm in the upper pole of the left kidney. The histological diagnosis of the referred mass was clear cell carcinoma. No metastatic lesion was found at that time (Stage I, pT2N0M0). CT scan showed a mass in the right nasal cavity, invading the right ethmoidal sinus and the right orbit. Examination under general anaesthesia and biopsy was performed revealing metastasis of a renal cell carcinoma. CONCLUSIONS: The natural history of renal cell carcinoma is highly variable, metastases may present decades after the removal of the primary disease, however, only 1% of patients with renal cell carcinoma have metastases confined only to the head and neck, and solitary cervical metastatic mass is rare. Moreover, renal cell carcinoma should be considered in the differential diagnosis of any growing lesion in the head and neck.

Recidiva tardía de un carcinoma de células renales. Metástasis maxilar derecha 17 años después de la primera cirugía / Late recurrence from a renal cell carcinoma: Solitary right maxilar mass 17 years after surgery

OBJETIVOS: Presentar un nuevo caso de recidiva tardía de un carcinoma de células renales.MÉTODOS: Los carcinomas renales suponen el 3% de todos los tumores en el adulto. Los lugares más frecuentes de afectación metastático son el pulmón (76%), ganglios linfáticos regionales (66%), hueso (42%) e hígado (41%), y además, es la tercera neoplasia infraclavicular en frecuencia en metastatizar en cabeza y cuello RESULTADOS: Varón de 73 años que consulta por episodio de epistaxis de 1 semana de evolución. El paciente había sido sometido a una nefrectomía izquierda por una masa de 8,5 cm en polo superior renal 17 años antes. El informe anatomo patológico fue de carcinoma renal de células claras. No se evidenciaron metástasis en los estudios de extensión previos a la cirugía (Estadio I, pT2N0M0). En el nuevo ingreso se realizó un escaner que mostró una masa en la cavidad nasal derecha que invadía en el seno etmoidal y la órbita derecha. Se llevó a cabo una exploración bajo anestesia con toma de biopsia confirmando la histología de carcinoma renal de células claras.CONCLUSIONES: La historia natural del cáncer renal es muy variable, pudiendo aparecer metástasis décadas después de la nefrectomía inicial, si bien sólo el 1% de estos pacientes presentan metástasis confinadas solamente a la cabeza y cuello. El carcinoma de células renales debe ser considerado en el diagnóstico diferencial de cualquier masa en cabeza y cuello(AU)

OBJECTIVES: To report a new case of late renal cell carcinoma recurrence.METHODS: Renal cell carcinoma represents approximately 3% of all adult malignancies. The most frequent metastatic sites are lung (76%), regional lymph nodes (66%), bone (42%), and liver (41%), and it is the third most common infraclavicular neoplasm to metastasize to head and neck.RESULTS: 73 year-old man with a 1 week history of recurrent epistaxis. He underwent left nephrectomy 17 years before due to a renal mass of 8.5 cm in the upper pole of the left kidney. The histological diagnosis of the referred mass was clear cell carcinoma. No metastatic lesion was found at that time (Stage I, pT2N0M0). CT scan showed a mass in the right nasal cavity, invading the right ethmoidal sinus and the right orbit. Examination under general anaesthesia and biopsy was performed revealing metastasis of a renal cell carcinoma.CONCLUSIONS: The natural history of renal cell carcinoma is highly variable, metastases may present decades after the removal of the primary disease, however, only 1% of patients with renal cell carcinoma have metastases confined only to the head and neck, and solitary cervical metastatic mass is rare. Moreover, renal cell carcinoma should be considered in the differential diagnosis of any growing lesion in the head and neck(AU)

Pancreatic and psoas abscesses as a late complication of intravesical administration of bacillus Calmette-Guerin for bladder cancer: a case report and review of the literature.

INTRODUCTION: Bacillus Calmette-Guerin (BCG) is a live attenuated strain of Mycobacterium bovis that has been used to treat urothelial carcinoma since 1976, and has been reported to eradicate disease in more than 70% of patients with in situ and stage I disease. To the best of our knowledge, we report the first case of disseminated bacillus Calmette-Guerin infection causing multiple abscesses affecting the pancreatic head and right psoas muscle, diagnosed 5 years after intravesical treatment with bacillus Calmette-Guerin therapy for bladder cancer. CASE PRESENTATION: An 83-year-old Caucasian man was hospitalized with a 2-month history of back pain, anorexia, generalized weakness and a 47-pound weight loss. He had previously undergone two transurethral resections for high-grade transitional cell carcinoma of the bladder and had received 12 intravesical bacillus Calmette-Guerin instillations without any complications. He complained of abdominal pain in his right flank. A computed tomography scan of the abdomen showed multiple abscesses affecting the pancreatic head and right psoas muscle. Growth of Mycobacterium bovis was determined in cultures of the purulent material obtained by surgical drainage of the abscesses. CONCLUSIONS: This case illustrates the fact that although intravesical administration of bacillus Calmette-Guerin is generally considered to be safe, it is not exempt from complications and these could appear immediately after treatment or as a delayed complication many years later.

[Significance of anemia as an independent prognostic factor in patients with renal cell carcinoma]. / Anemia como factor pronóstico independiente en pacientes con carcinoma renal.

BACKGROUND AND OBJECTIVE: The aim of this study was to analyze the significance of anemia as well as other prognostic factors influencing survival in patients with renal cell carcinoma (RCC). PATIENTS AND METHODS: A retrospective review of data of 316 patients who underwent surgery between 1970 and 2003 was performed. Most important known prognostic factors of RCC were investigated. RESULTS: Most of patients had T1b-T2, low nuclear grade and single tumours. In 8.2% and 9% of cases, lymph node and metastatic dissemination were detected at the time of diagnosis, respectively. At the beginning, most frequent symptoms were hematuria and pain, with anemia (Hb >10g/dl) in 69 patients. After a median follow-up of 50 months, 24.1% of patients had a recurrence. From these, more than 50% developed recurrence within one year after nephrectomy. Advanced tumours (T3-4) consisted of high nuclear grade (III-IV) tumours, larger size tumours, with necrosis and vascular infiltration in surgical specimen, as well as lymph node and metastatic dissemination. In multivariate analysis, anemia, time to recurrence, type of treatment for recurrence as well as lymph node dissemination were independent factors of cancer specific survival. CONCLUSION: Anemia seems to be a marker of recurrence and progression in patients with renal cell carcinoma undergoing nephrectomy. From our point of view, anemia could be considered a significantly high mortality rate for renal cancer in these patients.

Metástasis subcutánea de cáncer de próstata / Subcutaneous metastasis of prostate cancer

OBJETIVOS: La tendencia a la diseminación del cáncer de próstata es sobre todo a los ganglios linfáticos regionales y hueso, y en una menor proporción a pulmón, hígado y cerebro. El hallazgo de metástasis en otras localizaciones es un hecho excepcional.El objetivo de este trabajo es revisar la frecuencia y características clínicas de las metástasis de adenocarcinoma de próstata en el tejido celular subcutáneo.MÉTODOS: Presentamos el caso de un varón de 71 años que se diagnosticó de un adenocarcinoma de próstata. Se realiza prostatectomía radical y colocación de esfínter artificial por incontinencia urinaria de esfuerzo.RESULTADOS: Durante el seguimiento evoluciona con progresion bioquímica, recidiva local y metástasis óseas, es diagnosticado de metástasis en tejido subcutáneo perirreservorio de esfínter artificial.CONCLUSIONES: El cáncer de próstata es una enfermedad muy prevalerte en nuestro medio, en la cuál el hallazgo clínico de metástasis en órganos distintos al hueso o ganglios linfáticos regionales, se sigue de un corto periodo de supervivencia. El diagnóstico de metástasis en el tejido subcutáneo es un hecho que tal vez estar infradiagnosticado debido su curso clínico indolente y que podría además no elevar las cifras de PSA, en cualquier caso es un dato de mal pronóstico(AU)

OBJECTIVES: Prostate cancer tends to spread to regional lymph nodes and bone, and, to a lesser degree, to lung, liver, and brain. Metastases in other locations are exceptional.To review the frequency and clinical characteristics of metastasis to subcutaneous cellular tissue in adenocarcinoma of the prostate.METHODS: The case of a 71-year-old man diagnosed of adenocarcinoma of the prostate is reported. The patient underwent radical prostatectomy and artificial sphincter for stress urinary incontinence.RESULTS: During follow-up the patient showed biochemical progression, local recurrence, and bone metastasis. The disease metastasized in the subcutaneous tissue around the reservoir of the artificial sphincter.CONCLUSIONS: Prostate cancer is highly prevalent in our part of the world. The clinical finding of metastasis in organs other than bone or regional lymph nodes is accompanied by a short survival. Metastases in subcutaneous tissue may be underdiagnosed due to its indolent clinical course and possible absence of PSA elevation. In any case, subcutaneous metastases have an unfavorable prognosis(AU)

[Ovarian metastasis of a primary renal cell carcinoma]. / Metástasis ovárica de carcinoma de células renales primario.

OBJECTIVE: We report one case of ovarian metastasis secondary to a renal clear cell carcinoma. METHODS/RESULTS: 52 year-old consulting for metrorrhagia with the initial diagnosis of primary ovarian carcinoma. Tumor dissemination work up tests reported a renal mass suggestive of ovarian metastasis. Surgery included hysterectomy, double annexectomy, and radical nephrectomy. Final diagnosis was renal clear cell carcinoma with ovarian metastasis. CONCLUSIONS: Metastases to the ovary pose a diagnostic problem in their interpretation, especially when they show a similar histology to the primary ovarian tumor. Due to therapeutic and prognostic implications, it is very important to differentiate if it is a primary ovarian tumor or a metastasis from a renal carcinoma.