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Cancer testicular bilateral: presentación de cuatro casos / Bilateral testicular cancer: a report of four cases

El cáncer testicular bilateral suponen el 2-5 % de todos los tumores de testículo, aunque actualmente esa prevalencia va aumentando. La edad media de aparición es de los 15-35 años y el 75 % de ellos se presenta metacrónicamente. Suele haber hallazgos histológicos similares en ambos testículos, siendo el tipo histológico más frecuente el seminoma. El factor de riesgo más importante en el desarrollo del cancer testicular es la presencia de neoplasia intratubular de células germinales. El tratamiento de elección es la orquiectomía radical , aunque en algunos casos seleccionados se puede realizar una cirugía conservadora del testículo Presentamos 4 casos atendidos en nuestro servicio, analizamos los factores de riesgo, manejo de los tumores y realizamos una revisión de la literatura médica

Bilateral testicular cancer represents from 2 to 5 % of all testicle tumors, even though this prevalence nowadays is increasing. The median age of presentation was from 15 to years and in approximately 75 % of them occurred metachronously. There used to be concordance in histological findings between both testicles, being seminoma the most common histological type. The most important risk factor in the development of testicular cancer is the presence of intratubular germ cell neoplasia. Radical orquiectomy is the treatment to choose, although in some carefully selected patients testis-sparing surgery may be considered. We present four cases attended in our medical service, we analize the risk factors, management of tumors and a medical literature review is done

[Cutaneous metastases of renal cell carcinoma]. / Metastasis cutánea de carcinoma de células renales.

Renal cell carcinoma has an unknown evolution. We report a case of a man with a skin metastases from renal cell carcinoma and an unfortunate result, five years after its radical surgical treatment. We review the literature and emphasize the need of a long and exhaustive surveillance in these patients.

Metástasis cutánea de carcinoma de células renales / Cutaneous metastases of renal cell carcinoma

El carcinoma de células renales se caracteriza por su evolución impredecible. Presentamos un caso clínico de aparición de metástasis cutánea de carcinoma renal de células claras con pronóstico ominoso, tras cinco años de tratamiento quirúrgico curativo del primario renal. Revisamos la literatura e incidimos en la necesidad de un seguimiento prolongado y exhaustivo en estos pacientes

Renal cell carcinoma has an unknown evolution. We report a case of a man with a skin metastases from renal cell carcinoma and an unfortunate result, five years after its radical surgical treatment. We review the literature and emphasize the need of a long and exhaustive surveillance in these patients

[Bilateral testicular cancer: a report of four cases]. / Cancer testicular bilateral: presentación de cuatro casos.

Bilateral testicular cancer represents from 2 to 5% of all testicle tumors, even though this prevalence nowadays is increasing. The median age of presentation was from 15 to years and in approximately 75% of them occurred metachronously. There used to be concordance in histological findings between both testicles, being seminoma the most common histological type. The most important risk factor in the development of testicular cancer is the presence of intratubular germ cell neoplasia. Radical orquiectomy is the treatment to choose, although in some carefully selected patients testis-sparing surgery may be considered. We present four cases attended in our medical service, we analize the risk factors, management of tumors and a medical literature review is done.

[Survival analysis for localized renal cell carcinoma. Prognostic value of 1997 TNM classification]. / Análisis de supervivencia de los carcinomas de células renales organo-confinados. Valor pronóstico de la clasificación TNM 1997.

BACKGROUND: The 5th edition of TNM classification for renal cell carcinoma changed the cut-off point of the tumor size for localized tumors, achieving a better distribution of patients with similar survival. Nevertheless, because of the variable evolution of renal cell carcinoma, the prognostic significance of tumor size is questioned as a staging criterion in organ-confined renal cell carcinoma. We analyse renal cell carcinoma specific survival and the prognostic significance of tumor size in I and II stage. METHODS: We made a retrospective study with 158 renal cell carcinoma surgically treated in our hospital along 12 years. It was created a data base with clinical variables from patient and tumor and analyzed pathological staging, nuclear grade and specific survival, overall stage I and II. RESULTS: 27 renal cell carcinoma were pT1 (17.08%), 52 pT2 (32.91%), 45 pT, (28.45%), 10 pT3B (6.32%), y 24 pT4 (15.18%). The specific survival at 5 years for pT1-pT2, I-II stage, was 100% and 94% respectively, and no statistic significant differences were found between stage I and II (log-rank test 0.53, p>0.05). The specific survival at 5 years for pT3a, pT3B, y pT4 was 76.5%, 66.6% y 38.4%. There was a significant difference in survival in accordance with the tumor location, intrarenal (T1 y T2) versus extrarenal (T3A, T3B, T4) (log-rank test 9.06, p< 0.05). According to nuclear grade we don't find significant differences for pT1 y pT2 (Fisher test, p=1). Regarding the relation between pT stage and nuclear grade of the tumor we obtained a chi-square inear tendency of 38.19, p<0.001. CONCLUSION: The differences in the evolution of the organ-confined renal cell carcinoma with respect to the tumor size may be due to other molecular and biological variables, probably associated with stage, not controlled in essays. The TNM classification for organ-confined renal cell carcinoma based in tumor size seems artificial. New revisions of the classification system are necessary to identify which organ-confined carcinoma will have unfavourable evolution and to include them in a different category.

Análisis de supervivencia de los carcinomas de células renales órgano-confinados. Valor pronóstico de la clasificación TNM 1997 / Survival analysis for localized renal cell carcinoma. Prognostic value of 1997 TNM classification

Introducción: En la 5ª edición de la clasificación TNM de 1997 para tumores renales se modificó el punto de corte del tamaño del tumor primario para los estadios I y II, permitiendo una mejor agrupación de pacientes con distinta supervivencia. Sin embargo, dada la variable evolución del carcinoma de células renales determinada por su agresividad biológica, se cuestiona la utilidad del tamaño tumoral como elemento pronóstico y de estadiaje. Se realiza un estudio de supervivencia del carcinoma de células renales para valorar si la nueva clasificación TNM para el estadio I y II es la que mejor predice la supervivencia basándose en el tamaño del tumor. Material y Método: Se ha realizado un estudio retrospectivo de 158 carcinomas de células renales intervenidos en nuestro hospital en un periodo de 12 años. Se ha creado una base de datos con variables clínicas debidas al paciente y al tumor, y se ha valorado estadio patológico, grado nuclear y supervivencia causa específica, centrándonos en los estadios I y II. Resultados: Según la categoría pT obtuvimos 27 pT1 (17,08%), 52 pT2 (32,91%), 45 pT3A (28,45%), 10 pT3B (6,32%), y 24 pT4 (15,18%). La supervivencia tumor-específica a los 5 años para pT1-pT2, estadio I-II, es de 100% y 94% respectivamente, sin encontrar diferencias estadísticamente significativas entre los estadios I y II (log-rank test 0,53, p no significativa). La supervivencia tumor-específica a los 5 años para la categoría pT3A, pT3B, y pT4 es de 76,5%, 66,6% y 38,4%. Encontrando una diferencia en la supervivencia estadísticamente significativa según la localización del tumor primario intrarrenal (T1 y T2) y la extrarrenal (T3A, T3B, T4) (log-rank test 9,06, p < 0.05). Para pT1 y pT2 no se encuentran diferencias estadísticamente significativas según el grado nuclear (test exacto de Fisher, p=1). Comparando la relación entre estadio pT y grado nuclear del tumor primario obtenemos un valor para X2 de tendencia lineal de 38,19, p<0.001. Conclusiones: Las diferencias en la evolución del carcinoma de células renales órgano-confinado según el tamaño tumoral pueden ser debidas a la existencia de otras variables biológicas y moleculares, posiblemente asociadas al estadio, que no se controlan en los estudios. La clasificación TNM en los carcinomas de células renales órgano-confinados basándose en el tamaño del tumor nos parece artificiosa. Son necesarias nuevas revisiones del sistema de clasificación para identificar qué grupo de pacientes con carcinoma de células renales órgano-confinado va a presentar evolución desfavorable e incluirlos en una categoría distinta

Background: the 5th edition of TNM classification for renal cell carcinoma changed the cut-off point of the tumor size for localized tumors, achieving a better distribution of patients with similar survival. Nevertheless, because of the variable evolution of renal cell carcinoma, the prognostic significance of tumor size is questioned as a staging criterion in organ-confined renal cell carinoma. We analyse renal cell carcinoma specific survival and the prognostic significance of tumor size in I and II stage. Methods: We made a retrospective study with 158 renal cell carcinoma surgically treated in our hospital along 12 years. It was created a data base with clinical variables from patient and tumor and analyzed pathological staging, nuclear grade and specific survival, overall stage I and II. Results: 27 renal cell carcinoma were pT1 (17.08%), 52 pT2 (32.91%), 45 pT3A (28.45%), 10 pT3B (6.32%), y 24 pT4 (15.18%). The specific survival at 5 years for pT1-pT2, I-II stage, was 100% and 94% respectively, and no statistic significant differences were found between stage I and II (log-rank test 0.53, p>0.05). The specific survival at 5 years for pT3A, pT3B, y pT4 was 76.5%, 66.6% y 38.4%. There was a significant difference in survival in accordance with the tumor location, intrarenal (T1 y T2) versus extrarenal (T3A, T3B, T4) (log-rank test 9.06, p< 0.05). According to nuclear grade we don’t find significant differences for pT1 y pT2 (Fisher test, p=1). Regarding the relation between pT stage and nuclear grade of the tumor we obtained a X2 inear tendency of 38.19, p<0.001. Conclusion: The differences in the evolution of the organ-confined renal cell carcinoma with respect to the tumor size may be due to other molecular and biological variables, probably associated with stage. not controlled in essays. The TNM classification for organ-confined renal cell carcinoma based in tumor size seems artificial. New revisions of the classification system are necessary to identify which organ-confined carcinoma will have unfavourable evolution and to include them in a different category

[Berdon syndrome (megacystis, microcolon, intestinal hypoperistalsis). Report of our cases]. / Síndrome de Berdon (megavejiga, microcolon, hipoperistalsis). Presentación de nuestros casos.

Berdon syndrome is a rare congenital malformation that consists in megacystis and severe intestinal malformations that condition the prognosis in most of the cases. We report the three cases diagnosticated between 1976-2003. Diagnosis, therapeutics aspects and evolution are discussed.

[Pyeloureteral duplicity and intrathoracic kidney]. / Duplicidad pieloureteral y riñón intratorácico.

Intrathoracic ectopia is an unusual ectopia that represents less than 5% of renal ectopia. The association of a duplex system and an intrathoracic renal ectopia is very rare. We report a case of a girl affected from these two anormalities, being the first case published in the literature reviewed. Presentation, diagnosis and therapeutic aspects are discussed.

Síndrome de Berdon (megavejiga, microcolon, hipoperistalsis): Presentación de nuestros casos / Berdon syndrome (megacystis, microcolon, intestinal hypoperistalsis): Report of our cases

El Síndrome de Berdon es una malformación congénita muy poco frecuente que asocia megavejiga y alteraciones intestinales severas, las cuales condicionan el pronóstico en la mayoría de los casos. Presentamos una revisión de tres casos diagnosticados en nuestro servicio en el periodo 1976-2003. Se comentan los aspectos diagnósticos, terapéuticos y la evolución (AU)

Berdon Syndrome is a rare congenital malformation that consists in megacystis and severe intestinal malformations that condition the prognosis in most of the cases. We report the three cases diagnosticated between 1976-2003. Diagnosis, therapeutics aspects and evolution are discussed (AU)

Duplicidad pieloureteral y riñón intratorácico / Pyeloureteral duplication and intrathoracic kidney

La ectopia renal intratorácica es un tipo de ectopia muy rara, representando menos del 5% de las ectopias renales. La asociación de duplicidad pieloureteral y ectopia intratorácica es infrecuente. Presentamos el caso de una niña afecta de esta asociación de anomalías, tratándose del primer caso descrito en la literatura revisada. Se comentan los estudios diagnósticos realizados, así como el tratamiento y evolución de la paciente (AU)

Intrathoracic ectopia is an unusual ectopia that represents less than 5% of renal ectopia. The association of a duplex system and an intrathoracic renal ectopia is very rare. We report a case of a girl affected from these two anormalyties, being the first case published in the literature reviewed. Presentation, diagnosis and therapeutic aspects are discussed (AU)

[Study of cathepsin D levels in invasive bladder cancer and its stroma. Correlation with tumor stage, cytological grade, lymph node metastasis and survival]. / Estudio de los niveles de catepsina D en el tumor vesical infiltrante y en su estroma, y de su correlación con el estadio tumoral, grado citológico, afectación ganglionar y supervivencia.

OBJECTIVE: The aim of this study was to evaluate cathepsin D as a prognostic marker in invasive bladder cancer and to determine its relationship with stage, grade, lymph-node metastasis and survival too. MATERIAL AND METHODS: An immunohistochemical staining of 32 radical cystectomy specimens suffering from transitional cell carcinoma was performed, using a monoclonal antibody anti-cathepsin D (Novocastra). We made a semicuantitative measurement of the cathepsin D expression in the tumor and in the peritumoral stroma in a 400 x microscopic high power field. Patient population was composed of 31 men and 1 woman with a mean age of 63.25 years. The mean follow up was 23.6 months. Stage was classified with the WHO 1997 classification. Grade was classified with the ISUP/WHO 1998 classification. For the statistical analysis the Chi-square test, Pearson's test R, the Kaplan Meier method and the log-rank test were used. RESULTS: The pathological stages of the surgical specimens were as follows: pTo:3.1% (1), pT1:12.5% (4), pT2:15.6% (5), pT3:34.4% (11). (p < 0.001) A high cytologic grade was found in 81.25% of the tumors. There was a 43.8% progression rate and 40.6% mortality. There was no statistically significant relationship among Cathepsin's D levels in the stroma and lymph node metastases, stage, or grade (p = 0.473, p = 0.604, p = 0.2423). There was no statistically significant relationship among Cathepsin's D levels in the tumor and lymph node metastases, stage or grade (p = 0.496, p = 0.722 and p = 0.461). The cathepsin D levels, neither in the stroma nor in the tumor, showed no influence neither on the disease free intervals nor in the survival rates (p = 0.785; p = 0.355 and p = 0.614; p = 0.601 respectively). CONCLUSIONS: Immunohistochemical Cathepsin D levels do not seem to play a role in the prognostic of transitional tumors of the urinary bladder.

Estudio de los niveles de catepsina D en el tumor vesical infiltrante y en su estroma, y de su correlación con el estadio tumoral, grado citológico, afectación ganglionar y supervivencia / Cathepsin D levels study in invasive bladder cancer and its stroma. Correlation with tumor stage grade, lymph-node metastasis and survival

OBJETIVO: Evaluar la catepsina D como marcador pronóstico en el carcinoma transicional vesical infiltrante y determinar su relación con variables pronósticas reconocidas como son el estadio, el grado y la afectación ganglionar.MATERIAL Y MÉTODOS: Se realizó una tinción inmunohistoquímica de 32 piezas de cistectomía radical afectadas por carcinoma transicional infiltrante, practicadas entre noviembre de 1996 y mayo de 1999, con anticuerpo monoclonal anti catepsina D (Novocastra), realizando una medición semicuantitativa de la expresión de catepsina en las células tumorales y en el estroma peritumoral por campo de 400x.La serie estudiada se compuso de 31 varones y una mujer con un rango de edad entre 41 y 75 años y una edad media de 63,25 años (Desviación estandard de 8,77) y un seguimiento medio de 23,6 meses (1 a 44 meses). Los estadios se clasificaron según la clasificación de la WHO de 1997. El grado citológico se clasificó según la clasificación de la ISUP /WHO de 1998.Para el análisis de las variables se utilizó el test Chi-Cuadrado y test R de Pearson. El test de supervivencia se realizó según el método de Kaplan Meier y los niveles de significado mediante el test del logaritmo del rango (log-rank test).RESULTADOS: Los estadios diagnosticados en el momento de realizar la cistectomía fueron: pTo:3,1 per cent (1), pT1:12,5 per cent (4), pT2:15,6 per cent (5), pT3:34,4 per cent (11), pT4: 34,4 per cent (11). (p<0,001).El 81,25 per cent de los tumores fueron de alto grado citológico y el 18,75 per cent de los tumores fue de bajo grado.Se apreció afectación ganglionar en el 40,7 per cent de los casos.Existió una progresión del 43,8 per cent y una mortalidad del 40,6 per cent.No se encontraron valores significativos de asociación entre el nivel de catepsina en el estroma y el grado de afectación ganglionar, estadio tumoral o grado citológico (p=0,473, p=0,604, p=0,2423 respectivamente), ni con los niveles de catepsina tumoral y los parámetros referidos anteriormente (p=0,496, p=0,722 y p=0,461 respectivamente).Los niveles de catepsina en el estroma y tumor no mostraron influencia en los intervalos libres de enfermedad (p=0,785 y p=0,355 respectivamente) ni sobre la supervivencia (p=0,614 y p=0,601).CONCLUSIÓN: En nuestra serie la determinación semicuantitativa de los niveles de catepsina D con métodos inmunohistoquímicos no aporta información pronóstica en el tumor vesical infiltrante (AU)

[Acute renal infarction. Report of 2 cases]. / Infarto renal agudo. Presentación de dos casos.

Diagnosis of acute renal infarction is often delayed or missed due to both the rarity of the disease and its unespecific clinical presentation. Definitive radiologic diagnosis often requires invasive procedures such as angiography. Computed tomography (CT) may be useful in diagnosing acute renal infarction and is considered the standard of reference for diagnosis of acute renal infarction, with the advantage of being non-invasive and potentially available 24 hours a day. We report two cases, in the first case we show a segmentary renal infarction; at the second one we report a case of complete renal infarction. Presentation, diagnosis and therapeutic aspects are discussed.

[Crossed renal ectopy with fusion: report of a case]. / Ectopia renal cruzada con fusión: presentación de un caso.

OBJECTIVE: To present a case of crossed fused renal ectopia that was incidentally discovered in a patient consulting for abdominal pain in the emergency department. METHODS: A 46-year-old patient consulted at the emergency department for abdominal pain. Assessment by diagnostic imaging techniques demonstrated a crossed renal ectopia and associated bone anomalies. RESULTS/CONCLUSIONS: Crossed renal ectopia is an uncommon congenital anomaly and in most of the cases usually presents with fusion of both kidneys. It can also be associated with congenital anomalies of other organs. No treatment is required unless there are other complications or superimposed pathologies.

Infarto renal agudo. Presentación de dos casos / Acute renal infarction. Report of two cases

El diagnóstico del infarto renal agudo es frecuentemente tardío o inadvertido, debido a lo poco común de la enfermedad y a la inespecificidad de su presentación clínica. El diagnóstico radiológico definitivo requiere en ocasiones procedimientos invasivos como la arteriografía. La tomografía axial computerizada (TAC) es útil en el diagnóstico del infarto renal agudo, y es considerada en la actualidad como la técnica de referencia, con la ventaja de ser una técnica no invasiva y estar disponible en cualquier momento. Presentamos dos casos clínicos, uno de infarto renal agudo segmentario y otro de infarto total. Se comentan las técnicas diagnósticas así como el tratamiento y la evolución de los pacientes (AU)

[Hydatidosis in a single location]. / Enfermedad hidatídica de localización única.

Hydatidosis in our country an important health problem because of its high prevalence. We present a case of renal Hydatidosis in which we point out the renal single location of the disease and emphasize that MRI helped us to find a correct preoperative diagnosis.

[The role of urethral catheterization in penile necrosis]. / Papel del sondaje uretral en la necrosis peneana.

Isolated penile necrosis is a rare entity, its main causes are diabetes mellitus and chronic renal failure. Only two cases related with urethral catheterization have been published in the literature. We present a case of penile necrosis in a patient with a Foley catheter, the possible role of the catheter in the etiology and its management are discussed.

[Leydig cell tumor: report of 2 cases]. / Tumor de células de Leydig: presentación de dos casos.

Tumors from the gonadal stroma represent 4% among testicular tumors. Leydig cell tumors are the most common neoplasms among them and account for 1-3% of all testicular tumors. Two cases of testicular Leydig cell tumors in adult patients are presented. Presentation, diagnosis and therapeutic aspects are discussed. Both were treated with radical orchiectomy through an inguinal approach. Cas 1 was diagnosed in a cryptorchid testis and developed hepatic metastasis that were successfully treated with chemotherapy. Cas 2 was incidentally diagnosed on ultrasound. Both of them remain alive and free of disease.