[Testicular germ cell tumours: descriptive study of 13 years of experience in the health care area of Badajoz]. / Estudio descriptivo de los tumores testiculares germinales: 13 años de experiencia en el area de salud de Badajoz.

OBJECTIVES: To describe the incidence of germ cell testicular tumors in our Center, their characteristics and therapy results. METHODS: Retrospective study of 66 cases of germ cell testicular tumors diagnosed in the Health Area of Badajoz between 1993 and 2005. RESULTS: Mean age of the time of diagnosis was 32 years (range 16-80 years), presenting a younger age patients with non seminomatous germ cell tumors (NSGCT) (mean age 30 years). 86.5% of the patients did not have risk factors associated with the diagnosis of germ cell testicular tumor. Testicular mass was the most frequent symptom, and a higher proportion of tumors were located in the left testicle (51.5%). Non seminomatous germ cell tumors were the most frequent histological type (64.8%). Stage I (72%) was the most frequent stage in the group of seminomatous tumors, in comparison with 68.5% of non seminomatous tumors. Stages II-III appeared in 34.4% of the NSGCT and 28% of seminomatous, having worse prognosis. 92% of the patients received adjuvant treatment with chemotherapy and/or radiotherapy, and curative surgery was the only treatment in the remainder 8%. Residual mass surgery was undertaken in five patients (stages IIa, IIc and IIIa). Eight of the 66 cases were lost for follow-up. Fifty-three of the 58 patients with follow-up are disease-free, 18 of them with more than five years of follow-up. CONCLUSIONS: An increased incidence of germ cell testicular tumors have been verified over last years, mainly NSGCT Nevertheless, the diagnosis of advanced stages of the disease has diminished in favour of initial stages, which have a better prognosis for the patient. Oncologycal treatment protocols have high cure rates, although a long-term follow-up is needed due to the natural history of these tumors.

Estudio descriptivo de los tumores testiculares germinales: 13 años de experiencia en el área de salud de Badajoz / Testicular germ cell tumours: descriptive study of 13 years of experience in the health care area of Badajoz

Objetivo: Descripción de la incidencia, las características tumorales y los resultados de la terapéutica aplicada en los tumores germinales testiculares diagnosticados en nuestro Centro. Método: Estudio retrospectivo de los 66 casos de tumores germinales diagnosticados en el Área de Salud de Badajoz en el período comprendido entre 1993 y 2005. Resultados: La edad media del diagnóstico de los tumores germinales de testículo (TGT) fue de 32 años (rango 16-80 años), presentando una edad más precoz los pacientes con tumores no seminomatosos (TGNS), media de 30 años. En un 86.5% de los paciente no se encontraron factores de riesgo relacionados con el diagnóstico de TGT. El hallazgo de una masa escrotal fue el síntoma mas frecuente y el tumor se localizó en mayor proporción en el testículo izquierdo (51.5%). Los tumores germinales no seminomatosos fueron la histopatología más común (64.8%). En el grupo de los tumores seminomatosos (TGTS), el estadio I (72%) fué el más diagnosticado frente al 68.5% de los no seminomatosos. Los estadios II-III se dieron en el 34.4% de los TGNS y 28% de los seminomas, conllevando peor pronóstico. El 92% de los pacientes recibió tratamiento adyuvante con quimioterapia y/o radioterapia, y se realizó cirugía curativa como único tratamiento en el 8% restante de los pacientes. Se practicó cirugía de masas residuales en 5 pacientes (estadios IIb, IIc y IIIa). Ocho de los 66 casos se han perdido en el seguimiento. De los 58 pacientes restantes, donde fue posible el control de la evolución, 53 pacientes están libre de enfermedad,18 de ellos con más de 5 años de seguimiento. Conclusiones: En los últimos años se verifica un aumento de la incidencia de TGT, sobre todo a expensa de los TGNS. Sin embargo, ha disminuido el diagnóstico en fase avanzada de la enfermedad en favor de estadios iniciales que confieren un mejor pronóstico para el paciente. Los protocolos de tratamiento oncológicos utilizados proporcionan una alta tasa de curabilidad, aunque debido a la historia natural de tumor, es necesario un seguimiento a largo plazo (AU)

Objectives: To describe the incidence of germ cell testicular tumors in our Center, their characteristics and therapy results. Methods: Retrospective study of 66 cases of germ cell testicular tumors diagnosed in the Health Area of Badajoz between 1993 and 2005. Results: Mean age of the time of diagnosis was 32 years (range 16-80 years), presenting a younger age patients with non seminomatous germ cell tumors (NSGCT) (mean age 30 years). 86.5% of the patients did not have risk factors associated with the diagnosis of germ cell testicular tumor. Testicular mass was the most frequent symptom, and a higher proportion of tumors were located in the left testicle (51.5%). Non seminomatous germ cell tumors were the most frequent histological type (64.8%). Stage I (72%) was the most frequent stage in the group of seminomatous tumors, in comparison with 68.5% of non seminomatous tumors. Stages II-III appeared in 34.4% of the NSGCT and 28% of seminomatous, having worse prognosis. 92% of the patients received adjuvant treatment with chemotherapy and/or radiotherapy, and curative surgery was the only treatment in the remainder 8%. Residual mass surgery was undertaken in five patients (stages IIa, IIc and IIIa). Eight of the 66 cases were lost for follow-up. Fifty-three of the 58 patients with follow-up are disease-free, 18 of them with more than five years of follow-up. Conclusions: An increased incidence of germ cell testicular tumors have been verified over last years, mainly NSGCT. Nevertheless, the diagnosis of advanced stages of the disease has diminished in favour of initial stages, which have a better prognosis for the patient. Oncologycal treatment protocols have high cure rates, although a long-term follow-up is needed due to the natural history of these tumors (AU)

Ascitis urinosa en trasplantado renal / Urinary ascites after kidney transplantation

Objetivo: Presentamos un caso clínico de ascitis urinosa secundaria a urinoma producido por una fístula piélica y de uréter proximal en un varón de 21 años, trasplantado renal. Métodos: El diagnóstico se estableció mediante análisis bioquímico de la colección y líquido ascítico y la manipulación conservadora de la vía urinaria mediante nefrostomía percutánea. Resultado: El caso fue resuelto mediante la reparación quirúrgica de la fístula. Conclusión: La ascitis urinosa representa una rara complicación en el paciente trasplantado renal, cuyo origen puede ser idiopático, o como en la mayoría de las veces, secundario a una fístula en la vía urinaria. En este caso su resolución puede conseguirse mediante manipulación conservadora de la vía urinaria, o si fracasa, mediante cirugía reparadora. pueden ser indicativos de un pronóstico desfavorable. Nosotros consideramos que este tipo de tumor adrenal debe de ser considerado histológicamente y biológicamente como un sarcoma de alto grado de origen endotelial (AU)

[Urine ascites in renal transplantation]. / Ascitis urinosa en trasplantado renal.

OBJECTIVE: To report a case of urinary ascites secondary to an urinoma produced by a pielic and proximal ureter fistula after kidney transplantation in a 21 year old male patient. METHODS: Diagnosis was established by biochemical analysis of the perirenal fluid collection and ascitic fluid, and conservative management of the urinary tract by percutaneous nephrostomy was undertaken. RESULTS: Surgical repair of the fistulae solved the case. CONCLUSIONS: Urinary ascites is an unusual complication after kidney transplantation. Urinary tract fistula is the etiology in most of the cases although it can be idiopathic. In the case of urinary tract fistulae, conservative management can solve the case and surgical repair is the option when conservative treatment fails.