Rectal Swabs for Detecting Multidrug Resistant Bacteria Prior to Transrectal Prostate Fusion Biopsy: A Prospective Evaluation of Risk Factor Screening and Microbiologic Findings.

OBJECTIVE: To assess the prevalence of fluoroquinolone resistant (QR) bacteria, multidrug resistant (MDR) bacteria and Enterococcus faecalis (E. faecalis) in rectal swabs of patients undergoing transrectal prostate biopsy and for evaluating if risk factor assessment is reliable for prediction of QR bacteria, MDR bacteria, or E. faecalis. PATIENTS AND METHODS: Two hundred consecutive patients received a rectal swab examination prior to transrectal magnetic resonance imaging-guided fusion biopsy, for evaluating the prevalence of QR bacteria, MDR bacteria, and E. faecalis. The results of a standardized risk factor questionnaire, assessing known prognosticators for higher prevalence of resistant bacteria in rectal flora were correlated with the occurrence of QR bacteria, MDR bacteria, and E. faecalis in rectal swabs. RESULTS: QR E. coli was detected in 12 patients (6%). Regarding MDR bacteria, extended spectrum ß- lactamase- producing E. coli occurred in 8 patients (4%). E. faecalis was found in 15 patients (7.5%). A total of 193 patients completed the risk factor questionnaire. Of those, 107 (53.2%) patients harbored no risk factors, while 86 (42.8%) had at least 1 risk factor, of which the most common was repeat biopsy. No association was found between any risk factor and occurrence of QR bacteria, MDR bacteria, or E. faecalis (P >.05). CONCLUSION: The prevalence of resistant germs in our cohort was lower compared to other series. Moreover, the rate of QR bacteria, MDR bacteria, or E. faecalis in rectal swabs was not reliably associated with risk factor assessment.

Effect of bladder neck sparing at robot-assisted laparoscopic prostatectomy on postoperative continence rates and biochemical recurrence.

OBJECTIVES: Previous studies reported improved continence recovery by bladder neck sparing (BNS) in prostate cancer patients treated with robot-assisted laparoscopic radical prostatectomy (RALP), without compromising biochemical recurrence (BCR). We compared the continence outcomes, surgical margin rates, and BCR risk of BNS vs. bladder neck reconstruction (BNR) patients during RALP. METHODS: Overall, 1,512 patients who underwent RALP with BNS or BNR between 2010 and 2017 in a single high-volume center, were identified. Logistic regression models tested the effect of BNS on continence and surgical margin rates. Cox regression models tested the effect of BNS on BCR. Continence was defined as the use of 0 or 1-safety pad per day. RESULTS: Three hundred and eighty-two vs. 1,130 patients underwent BNS vs. BNR. The median time to catheter removal was significantly shorter (5 vs. 8 days) in patients with BNS. Pad-free rates at 7 days after catheter removal were 60.0% vs. 54.5%, continence rates were 80.1% vs. 78.3% after 3 months and 85.3% vs. 89.6% after 1 year for BNS and BNR, respectively. Multivariable models revealed that BNS is an independent predictor to be pad-free at 7 days after catheter removal (OR: 1.39, P = 0.04), but no predictor for continence at 3 months (OR: 1.02, P = 0.9) and 1 year (OR: 0.78, P = 0.4) after RALP, as well as for positive surgical margin (OR: 0.95, P = 0.8) and BCR (Hazard ratio: 0.95, P = 0.9). CONCLUSION: Patients with BNS had a better chance to be pad-free at 7 days after catheter removal and had a significant shorter time to catheter removal. However, this beneficial effect disappeared with time and no differences in continence rates at 3 months and 1 year were recorded. Moreover, BNS did not negatively affect positive margin or BCR rates.

[Urachal adenocarcinoma of the bladder, our experience in 20 years]. / Adenocarcinoma de uraco, nuestra experiencia en 20 años.

OBJECTIVE: To report two cases of urachal adenocarcinoma and to review the published literature. METHODS / RESULTS: We present a review of our urachal carcinoma cases from a third level hospital between 1990-2011 in an area of 520.000 inhabitants. Both cases were middle aged men, consulting for repeated urine infections, and abdominal mass with hematuria and mucous discharge through the urethra. They were treated initially with partial cystectomy and adjuvant treatment with chemotherapy in one case, and chemo and radiotherapy in the other. The first case died in 3 years and the other is still alive after 4 years of follow up. CONCLUSIONS: Urachal adenocarcinomas of the bladder are rare tumors the natural history of which has not changed during the last years. Open partial cystectomy with en bloc resection of the bladder dome, urachus and the umbilicus is the standard treatment in localized stages, although minimal invasive techniques appear to have the same oncological outcomes. Pelvic lymphadenectomy is advised. Most of the patients are diagnosed at an advanced local or metastatic stage. There is a need to improve diagnostic techniques for early treatment and to find new chemotherapy protocols that can help to improve these patients' survival.

Adenocarcinoma de uraco, nuestra experiencia en 20 años / Urachal adenocarcinoma of the bladder, our experience in 20 years

OBJETIVO: Presentar dos casos de adenocarcinoma de uraco y realizar una revisión de la literatura publicada. Método/RESULTADO: Se presenta una revisión de nuestros casos de adenocarcinoma de uraco de nuestro hospital terciario entre 1990 y 2011 en un área de 520.000 habitantes. Ambos casos eran hombres de mediana edad, que consultaron por infecciones urinarias repetidas, hematuria, masa abdominal y secreción mucosa por la uretra. Inicialmente se les realizó una cistectomía parcial con quimioterapia adyuvante en un caso, y quimio y radioterapia en el otro. Uno de los pacientes precisó una cistectomía radical de rescate. El primer paciente falleció por progresión a los 3 años y el segundo continúa vivo tras 4 años de seguimiento. CONCLUSIONES: Los adenocarcinomas de uraco de la vejiga son tumores raros cuya historia natural no ha cambiado en los últimos a pesar de nuevos protocolos de quimioterapia. La cistectomía parcial abierta con resección en bloque de la cúpula de la vejiga, el uraco y el ombligo es el tratamiento estándar en estadios localizados. La mayoría de los pacientes son diagnosticados en una etapa local avanzada o metastásica. Se necesitan nuevos protocolos quimioterápicos que permitan aumentar la SPV en estadíos avanzados

OBJECTIVE: To report two cases of urachal adenocarcinoma and to review the published literature. Methods/ RESULTS: We present a review of our urachal carcinoma cases from a third level hospital between 1990- 2011 in an area of 520.000 inhabitants. Both cases were middle aged men, consulting for repeated urine infections, and abdominal mass with hematuria and mucous discharge through the urethra. They were treated initially with partial cystectomy and adjuvant treatment with chemotherapy in one case, and chemo and radiotherapy in the other. The first case died in 3 years and the other is still alive after 4 years of follow up. CONCLUSIONS: Urachal adenocarcinomas of the bladder are rare tumors the natural history of which has not changed during the last years. Open partial cystectomy with en bloc resection of the bladder dome, urachus and the umbilicus is the standard treatment in localized stages, although minimal invasive techniques appear to have the same oncological outcomes. Pelvic lymphadenectomy is advised. Most of the patients are diagnosed at an advanced local or metastatic stage. There is a need to improve diagnostic techniques for early treatment and to find new chemotherapy protocols that can help to improve these patients' survival

Prostate sarcoma: report of 2 cases and bibliographic review.

OBJECTIVE: To report two cases of prostate sarcoma and perform a review of the published literature. METHODS / RESULTS: The first case is a 21 year old patient who presented acute urine retention and lung metastases on diagnosis. He was diagnosed by TURP of rhabdomyosarcoma of the prostate dying 1 month after surgery. The second case was a 33 years old male who presented to the emergency room with anal pain, urinary symptoms, hematochezia and loss of 20 kg over the past 3 months. Abdominal CT scan showed an 11 x 10 x 9 cm mass in the lower pelvis that infiltrated the bladder and rectum, being unable to define its origin. CA 19.9, CEA and PSA were normal. The suspected diagnosis was a prostate sarcoma infiltrating rectum and bladder. A pelvic exenteration was performed with a wet colostomy. The pathologic diagnosis was a high grade sarcoma not clearly identified of the prostate. He was treated with adriamycin as adjuvant chemotherapy, having local recurrence, nodal involvement and multiple pulmonary metastases after 3 months of follow up CONCLUSIONS: Prostate sarcomas are rare tumors. This makes difficult to know their natural history. Their rapid progression and systemic spread, despite multimodal treatment, gives a mean survival of 24 months. Main survival factors are grade, a complete resection of the tumor and a low local stage. There is a need to find new chemotherapy protocols to increase survival rates as it has been shown in extremities sarcomas.

Sarcoma de próstata: presentación de 2 casos y revisión de la literatura / Prostate sarcoma: report of 2 cases and bibliographic review

OBJETIVO: Presentar dos casos de sarcoma de próstata y realizar una revisión de la literatura publicada. METODO/RESULTADO: El primer caso es un paciente de 21 años de edad que acudió por retención aguda de orina y metástasis pulmonares al momento del diagnóstico. Fue diagnosticado por RTU de rabdomiosarcoma de próstata falleciendo un mes después de la cirugía. El otro paciente era un varón de 33 años que acude a urgencias por proctalgia, síntomas miccionales, hematoquecia y pérdida de 20 kg durante los 3 últimos meses. El TAC abdominal muestra una gran masa de 11x10x9 cm en pelvis inferior que desplaza anteriormente la vejiga e infiltra el recto sin poder concretar su origen. Los marcadores CA 19.9, CEA y PSA/s no presentaban alteraciones. La RMN orientó hacia un sarcoma de próstata que infiltraba vejiga y recto. Se realizó una exanteración pélvica con colostomía húmeda. El diagnóstico definitivo fue de sarcoma fusocelular de próstata de alto grado con infiltración de recto y vejiga. Se administró tratamiento quimioterápico adyuvante con Adriamicina, presentando a los 3 meses recidiva local y múltiples metástasis pulmonares. CONCLUSIONES: Los sarcomas de próstata son tumores poco frecuentes, lo cual dificulta el conocimiento de su historia natural. La progresión local y a distancia es muy rápida, con una supervivencia media de 2 años, a pesar del manejo terapéutico multimodal. El principal factor de supervivencia es una resección completa del tumor y un estadío local poco avanzado. Es necesario buscar nuevos protocolos quimioterápicos que permitan prolongar la supervivencia de estos pacientes como se ha demostrado en otro tipo de sarcomas

OBJECTIVE: To report two cases of prostate sarcoma and perform a review of the published literature. METHODS / RESULTS: The first case is a 21 year old patient who presented acute urine retention and lung metastases on diagnosis. He was diagnosed by TURP of rhabdomyosarcoma of the prostate dying 1 month after surgery. The second case was a 33 years old male who presented to the emergency room with anal pain, urinary symptoms, hematochezia and loss of 20 kg over the past 3 months. Abdominal CT scan showed an 11 x 10 x 9 cm mass in the lower pelvis that infiltrated the bladder and rectum, being unable to define its origin. CA 19.9, CEA and PSA were normal. The suspected diagnosis was a prostate sarcoma infiltrating rectum and bladder. A pelvic exenteration was performed with a wet colostomy. The pathologic diagnosis was a high grade sarcoma not clearly identified of the prostate. He was treated with adriamycin as adjuvant chemotherapy, having local recurrence, nodal involvement and multiple pulmonary metastases after 3 months of follow up. CONCLUSIONS: Prostate sarcomas are rare tumors. This makes difficult to know their natural history. Their rapid progression and systemic spread, despite multimodal treatment, gives a mean survival of 24 months. Main survival factors are grade, a complete resection of the tumor and a low local stage. There is a need to find new chemotherapy protocols to increase survival rates as it has been shown in extremities sarcomas

Mesothelioma of the tunica vaginalis. Case report.

OBJECTIVE: To report a case of a mesothelioma of the tunica vaginalis and to review the published literature. METHODS / RESULTS: A 61-year-old patient complained of one-month increase of right scrotum size with pain. An ultrasound showed a right hydrocele with a mass attached to the tunica vaginalis. He didn't refer any urological history or known exposure to asbestos. Blood levels of tumor markers (alpha-fetoprotein and beta-HCG) were within normal limits. We performed a radical inguinal orchiectomy with an en-bloc resection of the tunica vaginalis. The pathology described a potentially malignant biphasic mesothelioma. The patient has remained asymptomatic with negative extension studies after 10 years of follow up. CONCLUSIONS: Paratesticular mesotheliomas are rare tumors (approximately 250 cases reported )with uncertain etiology (only 30-40% are associated with asbestos exposure). The age range is between 50-70 years. Its presentation is usually as a scrotal mass with recurrent reactive hydrocele, which may delay early diagnosis. During surgery, intraoperative biopsy is recommended. It is important to do a differential diagnosis with other benign diseases. Treatment is only curative in early stages with radical orchidectomy and resection in-block of the tunica vaginalis. Despite being multidisciplinary, it is not curative in most cases due to rapid local and distant spread.

Mesotelioma de la túnica vaginal / Mesothelioma of the tunica vaginalis. Case report

OBJETIVO: Presentar un caso de mesotelioma testicular y realizar una revisión de la literatura publicada. MÉTODOS/RESULTADOS: Varón de 61 años que consulta por aumento del hemiescroto derecho desde hace 1 mes asociado a dolor. En una ecografía se visualizó hidrocele derecho con una masa en el interior. No refería ningún antecedente urológico de interés ni exposición conocida a asbestos. Los niveles sanguíneos de los marcadores tumorales alfa fetoproteína y beta-HCG estaban en dentro de la normalidad. Se realizó una orquiectomía radical vía inguinal con extirpación de la vaginal en bloque. La anatomía patológica describía un mesotelioma bifásico de la tunica vaginal potencialmente maligno. El paciente ha permanecido asintomático con periódicos estudios de extensión negativos tras 10 años de seguimiento. CONCLUSIONES: Los mesoteliomas testiculares son tumores muy poco frecuentes (aprox. 250 casos publicados) con una etiología incierta (sólo el 30-40% están asociados con exposición a asbesto) y una edad de presentación de entre los 50-70 años. Suelen manifestarse como una masa escrotal con hidrocele reactivo y recidivante, lo cual puede dificultar un diagnóstico precoz. Durante la cirugía se recomienda realizar biopsias intraoperatorias para obtener un diagnostico de certeza. Es importante realizar un diagnóstico diferencial con otras patologías benignas. El tratamiento sólo es curativo en estadios precoces mediante orquiectomía radical con extirpación en bloque de la vaginal. En la mayoría de los casos hay una rápida diseminación local y a distancia con mal pronostico a pesar de un tratamiento multidisciplinar (AU)

OBJECTIVE: To report a case of a mesothelioma of the tunica vaginalis and to review the published literature. METHODS / RESULTS: A 61-year-old patient complained of one-month increase of right scrotum size with pain. An ultrasound showed a right hydrocele with a mass attached to the tunica vaginalis. He didn’t refer any urological history or known exposure to asbestos. Blood levels of tumor markers (alpha-fetoprotein and beta-HCG) were within normal limits. We performed a radical inguinal orchiectomy with an en-bloc resection of the tunica vaginalis. The pathology described a potentially malignant biphasic mesothelioma. The patient has remained asymptomatic with negative extension studies after 10 years of follow up. CONCLUSIONS: Paratesticular mesotheliomas are rare tumors (approximately 250 cases reported) with uncertain etiology (only 30-40% are associated with asbestos exposure). The age range is between 50-70 years. Its presentation is usually as a scrotal mass with recurrent reactive hydrocele, which may delay early diagnosis. During surgery, intraoperative biopsy is recommended. It is important to do a differential diagnosis with other benign diseases. Treatment is only curative in early stages with radical orchidectomy and resection in-block of the tunica vaginalis. Despite being multidisciplinary, it is not curative in most cases due to rapid local and distant spread (AU)

Cyst of the skene's gland: report of four cases and bibliographic review.

OBJECTIVES: To show our experience with 4 cases of cysts of the Skene's gland and a review of the published literature. METHODS/RESULTS: Diagnosis and treatment of 4 cases of Skene's gland cyst. CONCLUSIONS: Skene's gland cyst is a lesion that rarely is treated by Urologists, because it doesn't usually have clinical repercussion, but when it's derived to us we have to make a complete study of the urinary tract to exclude complications or different serious lesions. Surgery is the treatment of choice, making a complete excision of the lesion and repair of urethral injuries. All cases evolved well without recurrence or fistulous complications.

Signet-ring cell adenocarcinoma of the bladder: case series between 1990-2009.

OBJECTIVES: To present a revision on the signet-ring cell bladder adenocarcinomas found in our department. METHODS/RESULTS: We reviewed all the transurethral resections of the bladder (TURB) performed between 1990 and 2009 finding 9 cases of primary signet ring cell adenocarcinomas (4 pure and 5 mixed). Eight were male and one female, with ages between 39 and 82 years. Definitive treatment was radical cystectomy with Bricker's urinary diversion in four patients, cysctectomy with Mainz's II diversion in one patient and palliative management with TURB in three cases and percutaneous nephrostomy in the remaining case. We used adyuvant chemotherapy in three cases. Only two patients were alive at the time of the study. Mean survival was 327 days for pure tumors and 586 for the mixed ones. CONCLUSIONS: Signet-ring cell primary adenocarcinoma of the bladder is an uncommon type of tumor, with worse prognosis than transitional cell cancer. It is important to discard other possible metastatic origins(like stomach, prostate, lung, or ovary) because the management will be different. Radical cystectomy is the treatment of choice, with adyuvant chemotherapy if possible. Five year survival is less than 11%

Quiste de la glándula de skene: 4 casos y revisión de la literatura / Cyst of Skene´s gland: report of four cases and bibliographic review

OBJETIVOS: Presentar nuestra experiencia con cuatro casos de quistes de las glándulas de Skene de gran tamaño, realizar una revisión de la literatura publicada y conocer así los distintos diagnósticos diferenciales y el manejo a seguir.MÉTODOS: Cuatro mujeres remitidas a nosotros desde su ginecólogo por presentar masas parauretrales refractarias a tratamiento conservador con posible afectación de la uretra distal.CONCLUSIONES: El quiste de la glándula de Skene es una patología que raramente tratan los urólogos debido a su escasa repercusión clínica pero cuando nos es remitida por los ginecólogos es importante realizar un estudio completo del aparato urinario para realizar así un diagnóstico diferencial certero que excluya patologías malignas o alteraciones del aparato urinario. El tratamiento de elección en los casos refractarios es quirúrgico, realizando una exéresis completa del quiste y reparando las posibles lesiones de la pared uretral. En todos los casos la evolución fue favorable sin presentar recidiva o complicaciones fistulosas(AU)

OBJECTIVES: To show our experience with 4 cases of cysts of the Skene´s gland and a review of the published literature.METHODS/RESULTS: Diagnosis and treatment of 4 cases of Skene´s gland cyst.CONCLUSIONS: Skene´s gland cyst is a lesion that rarely is treated by Urologists, because it doesn’t usually have clinical repercussion, but when it´s derived to us we have to make a complete study of the urinary tract to exclude complications or different serious lesions. Surgery is the treatment of choice, making a complete excision of the lesion and repair of urethral injuries. All cases evolved well without recurrence or fistulous complications(AU)

Adenocarcinoma vesical de células en anillo de sello: revisión de nuestros casos entre 1990-2009 / Signet-ring cell adenocarcinoma of the bladder: case review between 1990-2009

OBJETIVOS: Presentar una revisión de los adenocarcinomas primarios de vejiga de células en anillo de sello de nuestro servicio. MÉTODO/RESULTADO: Revisamos las RTU de vejiga realizadas entre 1990 y 2009 encontrando 9 casos de tumores primarios de vejiga de células en anillo de sello (4 puros y 5 mixtos).8 eran varones y 1 mujer, con edades comprendidas entre los 39 y los 82 años. Tratamiento definitivo consistió en cistectomía radical con derivación tipo Bricker en cuatro de los pacientes, cistectomía con derivación Mainz II en otro de ellos y paliativo en los cuatro restantes con RTU en tres casos y NPC paliativas en otro. Empleamos quimioterapia adyuvante en 3 casos. Sólo dos de los pacientes estaban vivos en el momento del estudio. La media de supervivencia fue de 327 días para los tumores puros y de 586 para los mixtos.CONCLUSIÓN: Los adenocarcinomas primarios de vejiga con células en anillo de sello son unos tumores poco frecuentes, con peor pronóstico que los de células transicionales. Es importante que descartemos los posibles orígenes metastásicos (de estómago, próstata, ovario, pulmón) ya que el manejo a seguir será distinto en función de la localización del tumor primario. El tratamiento de elección en los primarios de vejiga es la cistectomía radical, con quimioterapia adyuvante en los casos que sea posible. La supervivencia a 5 años es < al 11%(AU)

OBJECTIVES: To present a revision on the signet-ring cell bladder adenocarcinomas found in our department.METHODS/RESULTS: We reviewed all the transurethral resections of the bladder (TURB) performed between 1990 and 2009 finding 9 cases of primary signet ring cell adenocarcinomas ( 4 pure and 5 mixed). Eight were male and one female, with ages between 39 and 82 years. Definitive treatment was radical cystectomy with Bricker´s urinary diversion in four patients, cysctectomy with Mainz´s II diversion in one patient and palliative management with TURB in three cases and percutaneous nephrostomy in the remaining case. We used adyuvant chemotherapy in three cases. Only two patients were alive at the time of the study. Mean survival was 327 days for pure tumors and 586 for the mixed ones.CONCLUSIONS: Signet-ring cell primary adenocarcinoma of the bladder is an uncommon type of tumor, with worse prognosis than transitional cell cancer. It is important to discard other possible metastatic origins (like stomach, prostate, lung, or ovary) because the management will be different. Radical cystectomy is the treatment of choice, with adyuvant chemotherapy if possible. Five year survival is less than 11%(AU)

Presentación testicular de un linfoma no Hodking tipo NK nasal y revisión de la literatura / Testicular presentation of a nasal type NK non Hodgkin lymphoma and review of the literature

Objetivos: Comunicar un caso de un tumor de células NK de tipo nasal originado en el testículo y realizar una revisión de la literatura publicada. Método/Resultado: Presentamos un paciente de 68 años de la edad, sin historia urológica previa, que acudió a nuestra consulta refiriendo desde hace 11 meses clínica de inflamación del teste derecho y afectación de la piel escrotal con mala respuesta a tratamiento antibiótico. Se realizó una orquiectomía por vía inguinal y se resecó la piel afectada. El diagnóstico histológico definitivo fue de linfoma no Hodgkin tipo NK nasal de células grandes. Posteriormente fue derivado al servicio de hematología que realizó un estudio de extensión confirmando con un frotis sanguíneo el diagnóstico de linfoma y tras estudiar al paciente se realizó un tratamiento sistémico con 3 ciclos de CHOP y profilaxis intratecal. Tras 20 meses de seguimiento desde el inicio de los síntomas el paciente no ha presentado afectación ganglionar o de algún otro órgano. Conclusiones: Los linfomas de células T/NK nasales son tumores poco frecuentes en nuestro medio siendo su presentación extra nasal toda una rareza y encontrado en la literatura revisada sólo 12 casos de esta presentación testicular. Es esencial el estudio anatomopatológico mediante inmunohistoquímica para clasificar dichos linfomas, ya que este tipo se caracteriza por una rápida diseminación sistémica y mala respuesta al tratamiento.

Objectives: To report a case of a nasal type NK cell tumor originated in the testicle and review the published literature. Method/Results: We report a 68 years old patient, without previous urological history, who came to our clinic referring clinical inflammation of the right testicle with scrotal skin involvement for eleven months, with poor response to antibiotic treatment. Inguinal orchiectomy was performed with resection of the affected skin. The definitive histologic diagnosis was nasal type NK large cell non-Hodgkin lymphoma. He was subsequently referred to Hematology which conducted an extension study and confirmed the lymphoma diagnosis with a blood smear. After staging, the patient underwent systemic treatment with 3 cycles of CHOP and intrathecal prophylaxis. After 20 months follow up from the onset of symptoms the patient has had no lymph node or other organ involvement. Conclusions: Nasal type T/NK cell lymphoma tumors are infrequent being extranasal presentation a rarity. We found only 12 cases of this testicular presentation in the literature. Pathological analysis using immunohistochemistry is essential to classify these lymphomas, as rapid systemic spread and poor response to treatment is characteristic is essential to classify these lymphomas, as rapid systemic spread and poor response to treatment is characteristic.

Hemorragia suprarrenal espontánea unilateral / Spontaneous unilateral adrenal hemorrhage

Hombre de 73 años que acude al servicio de urgencias por dolor abdominal. Al examen físico se palpa masa que ocupa hipocondrio derecho. Angio TAC muestra masa abdominal de 12 cm dependiente de glándula suprarrenal derecha. Analítica de orina muestra elevación de metanefrinas y normetanefrinas. La gamagrafía fue compatible con feocromocitoma. Se realiza extirpación quirúrgica de masa y la anatomía patológica describe hemorragia suprarrenal sin malignidad.

A 73 year old man, came to the emergency department referring abdominal pain. A palpable mass occupying right upper quadrant on physical examination was identified. CT angiography showed a 12 cm abdominal mass dependent of the right adrenal. Urinalysis showed elevation of metanephrines and normetanephrines. Gamagraphy scan was compatible with pheochromocytoma. Surgical resection of the mass was performed and pathology described an adrenal hemorrhage without malignancy.

Giant cystic degeneration of the rete testis.

OBJECTIVES: We present a case of giant cyst of the rete-testis. METHODS/RESULTS: 85 year-old patient on follow -up for prostate cancer with maximum androgen blockade (MAB) treatment consults for a left hemiscrotum increase in size over a 2-month period. We performed bilateral orchiectomy confirming the histopathological diagnosis of cystic dilatation of the rete-testis sized 11 x 11 x 9 cm. CONCLUSIONS: This case of cystic degeneration of the rete-testis, with a size out of common (11 x 11 x 9 cm versus medium size in the literature: 3 x 3 x 3 cm), could be related with an androgen-estrogen misbalance caused by a MAB in a prostate cancer context.

Degeneración quística gigante de la rete testis / Giant cystic degeneration of the rete testis

OBJETIVOS: Presentar el caso de un quiste gigante de la rete testis.MÉTODO/RESULTADO: Se trata de un paciente de 85 años que durante el seguimiento por un adenocarcinoma de próstata con bloqueo androgénico completo consulta por aumento del tamaño del hemiescroto izquierdo de dos meses de evolución. Se realizó una orquiectomía bilateral, confirmando en el estudio histopatológico de dilatación quística de la rete testis de 11x11x9cm de tamaño. CONCLUSIÓN: Este caso de degeneración quística de la rete testis, con un tamaño fuera de lo común (11x11x9cm, mientras que en la literatura refieren un tamaño medio de 3x3x3cm) podría estar relacionado con el disbalance andrógeno-estrogénico por el BAC en el contexto de un cáncer de próstata(AU)

OBJECTIVES: We present a case of giant cyst of the rete-testisMETHODS/RESULTS: 85 year-old patient on follow-up for prostate cancer with maximum androgen blockade (MAB) treatment consults for a left hemiscrotum increase in size over a 2-month period. We performed bilateral orchiectomy confirming the histopathological diagnosis of cystic dilatation of the rete-testis sized 11x11x9cm.CONCLUSIONS: This case of cystic degeneration of the rete-testis, with a size out of common (11x11x9cm versus medium size in the literature: 3x3x3cm), could be related with an androgen-estrogen misbalance caused by a MAB in a prostate cancer context(AU)