Vulvar cancer staging: guidelines of the European Society of Urogenital Radiology (ESUR).

OBJECTIVE: The aim of the Female Pelvic Imaging Working Group of the European Society of Urogenital Radiology (ESUR) was to develop imaging staging guidelines for vulvar cancer and to propose standardised MRI protocols and reporting. METHODS: The guidelines recommended from the ESUR in this article resulted from a questionnaire analysis regarding imaging staging of vulvar cancer that was answered by all members of the Female Pelvic Imaging Working Group. Only the answers with an agreement equal to or more than 80% were considered. Additionally, the literature was reviewed to complement and further support our conclusions. RESULTS: The critical review of the literature and consensus obtained among experts allows for recommendations regarding imaging staging guidelines, patient preparation, MRI protocol, and a structured MRI report. CONCLUSIONS: Standardising image acquisition techniques and MRI interpretation reduces ambiguity and ultimately improves the contribution of radiology to the staging and management of patients with vulvar cancer. Moreover, structured reporting assists with the communication of clinically relevant information to the referring physician.

Resonancia magnética de próstata: lectura con el sistema PI-RADS V2 / Magnetic resonance imaging of the prostate: interpretation using the PI-RADS V2

Objetivo. El sistema de datos e informe en imagen prostática (Prostate Imaging and Reporting and Data System, PI-RADS) en su versión 2 fue creado con el fin de ayudar en la detección, localización y caracterización del cáncer de próstata con resonancia magnética (RM). Sus recomendaciones de estandarización de parámetros de adquisición de imágenes pretenden disminuir la variabilidad en la interpretación de los estudios de RM prostática, lo que, junto con la realización de un informe estructurado, tiene el valor añadido de mejorar la comunicación entre los radiólogos, y entre estos y los urólogos. El objetivo de nuestro trabajo es explicar de manera sencilla el sistema de clasificación PI-RADS v2 mediante imágenes ilustrativas de cada una de las categorías, así como recomendar el uso de una técnica estándar que ayude en la reproducibilidad de los estudios de RM multiparamétrica. Conclusión. El documento PI-RADS v2 es sencillo de aplicar a la lectura de la RMmp de próstata. Es importante que los radiólogos dedicados a la imagen prostática lo incluyamos en la práctica diaria para realizar informes claros y concisos que mejoren la comunicación entre radiólogos y urólogos (AU)

Objective. Version 2 of the Prostate Imaging and Reporting and Data System (PI-RADS) was developed to help in the detection, location, and characterization of prostate cancer with magnetic resonance imaging (MRI). Its recommendations for standardizing image acquisition parameters aims to reduce variability in the interpretation of MRI studies of the prostate; this approach, together with structured reporting, has the added value of improving communication among radiologists and between radiologists and urologists. This article aims to explain the PI-RADS v2 classification in a simple way, using illustrative images for each of the categories, as well as to recommend the use of a standard technique that helps ensure the reproducibility of multiparametric MRI. Conclusion. The PI-RADS v2 is simple to appy when reading multiparametric MRI studies of the prostate. It is important for radiologists doing prostate imaging to use the PI-RADS v2 in daily practice to write clear and concise reports that improve communication between radiologists and urologists (AU)

Magnetic resonance imaging of the prostate: interpretation using the PI-RADS V2. / Resonancia magnética de próstata: lectura con el sistema PI-RADS V2.

OBJECTIVE: Version 2 of the Prostate Imaging and Reporting and Data System (PI-RADS) was developed to help in the detection, location, and characterization of prostate cancer with magnetic resonance imaging (MRI). Its recommendations for standardizing image acquisition parameters aims to reduce variability in the interpretation of MRI studies of the prostate; this approach, together with structured reporting, has the added value of improving communication among radiologists and between radiologists and urologists. This article aims to explain the PI-RADS v2 classification in a simple way, using illustrative images for each of the categories, as well as to recommend the use of a standard technique that helps ensure the reproducibility of multiparametric MRI. CONCLUSION: The PI-RADS v2 is simple to appy when reading multiparametric MRI studies of the prostate. It is important for radiologists doing prostate imaging to use the PI-RADS v2 in daily practice to write clear and concise reports that improve communication between radiologists and urologists.

El radiólogo invisible / The invisible radiologist

No disponible

Electrolytic lesion of the nucleus incertus retards extinction of auditory conditioned fear.

Fear memory circuits in the brain function to allow animals and humans to recognize putative sources of danger and adopt an appropriate behavioral response; and research on animal models of fear have helped reveal the anatomical and neurochemical nature of these circuits. The nucleus (n.) incertus in the dorsal pontine tegmentum provides a strong GABAergic projection to forebrain 'fear centers' and is strongly activated by neurogenic stressors. In this study in adult male rats, we examined the effect of electrolytic lesions of n. incertus on different stages of the fear conditioning-extinction process and correlated the outcomes with anatomical data on the distribution of n. incertus-derived nerve fibers in areas implicated in fear circuits. In a contextual auditory fear conditioning paradigm, we compared freezing behavior in control (naïve) rats (n=23) and rats with sham- or electrolytic lesions of n. incertus (n=13/group). The effectiveness and extent of the lesions was assessed post-mortem using immunohistochemical markers for n. incertus neurons-calretinin and relaxin-3. There were no differences between the three experimental groups in the habituation, acquisition, or context conditioning phases; but n. incertus lesioned rats displayed a markedly slower, 'delayed' extinction of conditioned freezing responses compared to sham-lesion and control rats, but no differences in retrieval of extinguished fear. These and earlier findings suggest that n. incertus-related circuits normally promote extinction through inhibitory projections to the amygdala, which is involved in acquisition of extinction memories.

Recidiva del cáncer de próstata después de la prostatectomía radical y radioterapia de rescate / Prostate cancer recurrence after radical prostatectomy and salvage radiotherapy

OBJETIVO: Evaluar la eficacia de la radioterapia en el lecho prostático en pacientes con cáncer de próstata y fracaso bioquímico después de la prostatectomía radical. MATERIAL Y MÉTODOS: Analizamos los resultados de 292 pacientes a los que se le practicó prostatectomía radical por cáncer de próstata localizado T1-T2, entre enero de 1992 y junio de 2003, con un seguimiento medio de 36 meses (rango 6 meses a 12 años). Se detecta fracaso bioquímico (PSA > 0,20 ng/ml) en 75 (26%) pacientes. De los 75 pacientes con fracaso bioquímico, 9 (12%) se diagnosticó de recidiva local siguiendo los siguientes criterios: a) Primer PSA obtenido a las 6 semanas de la intervención 6 meses. c) Tiempo de duplicación del PSA > 6 meses. d) Velocidad de PSA después de la prostatectomía radical <0,75/ng/ml/año. e) Nivel de PSA después de la prostatectomía radical <2,5 ng/ml. Los 9 pacientes diagnosticados de recidiva local reciben una dosis media de 56,42 Gy en el lecho prostático. RESULTADOS: De los 9 pacientes diagnosticados de recidiva local, en 7 (77,7%) se obtuvo una respuesta completa durante un tiempo medio de seguimiento de 25 meses (6-30 meses). El tiempo entre la radioterapia y la respuesta, en los pacientes con respuesta completa, siempre fue inferior a los 3 meses. No se observaron efectos adversos importantes secundarios a la radioterapia. CONCLUSIONES: La radioterapia de rescate puede ser beneficiosa en un seleccionado grupo de pacientes con recidiva local. La cinética del PSA después de la prostatectomía radical es útil para distinguir las recidivas locales de las metástasis a distancia

OBJETIVE: To evaluate the efficacy of the radiotherapy to prostatic bed in patients with biochemical recurrence for prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the results of 292 patients underwent radical prostatectomy for localized prostate cancer T1-T2 between January 1992 and June 2003, with an average folow-up of 36 months (range 6 months to 12 years). We detect biochemical recurrence (PSA >0.20 ng/ml) in 75 (26%) patients. Of 75 patients with biochemical recurrence, 9 (12 %) was diagnosed of local recurrence by the following criteria: a) The first PSA obtained 6 weeks after radical prostatectomy 6 months. c) The prostate specific antigen doubling time >6 months. d) The prostate specific antigen velocity after radical prostatectomy <0.75 ng/ml/year. e) The prostate specific antigen level after radical prostatectomy <2.5 ng/ml. The 9 patients diagnosed of local recurrence received an average dose of 56.42 Gy in the prostate bed. RESULTS: Of all 9 patients with local recurrence, 7 (77.7%) has complete response with an average time of followup of 25 months (6-30 months). The time between the radiotherapy and the response, in patients with complete response, was lower than 3 months. Were not observed significant adverse effects associated to radiotherapy. CONCLUSIONS: The salvage radiotherapy may be beneficial in select patients with local recurrence. The characteristics of prostate specific antigen elevation are useful in distinguishing men with local recurrence from those with distant metastases

[Prostate cancer recurrence after radical prostatectomy and salvage radiotherapy]. / Recidiva del cáncer de próstata después de la prostatectomía radical y radioterapia de rescate.

OBJECTIVE: To evaluate the efficacy of the radiotherapy to prostatic bed in patients with biochemical recurrence for prostate cancer after radical prostatectomy. MATERIAL AND METHODS: We analyse the results of 292 patients underwent radical prostatectomy for localized prostate cancer T1-T2 between January 1992 and June 2003, with an average folow-up of 36 months (range 6 months to 12 years). We detect biochemical recurrence (PSA >0.20 ng/ml) in 75 (26%) patients. Of 75 patients with biochemical recurrence, 9 (12%) was diagnosed of local recurrence by the following criteria: a) The first PSA obtained 6 weeks after radical prostatectomy <0.20 ng/ml. b) The time to biochemical recurrence >6 months. c) The prostate specific antigen doubling time >6 months. d) The prostate specific antigen velocity after radical prostatectomy <0.75 ng/ml/year. e) The prostate specific antigen level after radical prostatectomy <2.5 ng/ml. The 9 patients diagnosed of local recurrence received an average dose of 56.42 Gy in the prostate bed. RESULTS: Of all 9 patients with local recurrence, 7 (77.7%) has complete response with an average time of follow-up of 25 months (6-30 months). The time between the radiotherapy and the response, in patients with complete response, was lower than 3 months. Were not observed significant adverse effects associated to radiotherapy. CONCLUSIONS: The salvage radiotherapy may be beneficial in select patients with local recurrence. The characteristics of prostate specific antigen elevation are useful in distinguishing men with local recurrence from those with distant metastases.

[Correlation of the anatomo-pathological staging of radical prostatectomy specimens with the amount of cancer in the preoperative sextant biopsy]. / Correlación del estadio anatomopatológico de la pieza de prostatectomía radical con la cantidad de cáncer en la biopsia sextante preoperatoria.

OBJECTIVE: We assess the value of the percent of cancer in needle cores of sextant biopsy for predicting the risk of extraprostatic extension at radical retropublic prostatectomy. MATERIAL AND METHODS: We reviewed prostate needle biopsy findings in 97 patients with prostate cancer T1c-T2, who subsequently underwent radical retropubic prostatectomy. In each needle biopsy were assessed, number of cores positive, percent of cores positive, percent cancer in all cores, Gleason score, intraepithelial neoplasia, perineural invasion and vascular invasion. Initial PSA and preoperative clinical stage were incorporated with biopsy results into a univariate and multivariate model to determine the parameters most predictive of pathological stage. RESULTS: Of the 97 patients, 72 (74%) had organ confined cancer and 25 (26%) had extraprostatic extension. The average of cores positive for organ confined cancer was 4.2 (median 4) vs. 6.9 (median 6) for extraprostatic extension (p = 0.001), the percent of cores positive for organ confined cancer was 34.9% (median 28) vs. 53.8% (median 46) for extraprostatic extension (p = 0.013). The average of cancer in all cores in organ confined cancer was 13.6% (median 6) vs. 30.5% (median 30) for extraprostatic extension (p = 0.002). The mean Gleason score in needle cores was 5.9 (median 6) in organ confined cancer vs. 6.6 (median 7) in extraprostatic extension (p = 0.007). The average of intraepithelial neoplasia in needle cores was 3 (4%) in organ confined cancer vs. 1 (4%) in extraprostatic extension (p = 0.972). The perineural invasion of needle cores was 6 (8.3%) in confined cancer vs. 4 (16%) in extraprostatic extension (p = 0.355). Univariate analysis demonstrated that the risk of extraprostatic extension is predicted by the number of cores positive (p = 0.003), the percent of cores positive (p = 0.006), the percent of cancer in all cores (p = 0.001), the Gleason score (p = 0.002), the clinical stage (p = 0.019) and initial PSA (p = 0.032). Extraprostatic extension is not predicted by the intraepithelial neoplasia (p = 0.971), vascular invasion and perineural invasion (p = 0.285). Multivariate analysis showed that the percent of cancer in all cores is the strongest predictor of extraprostatic extension (p = 0.035). With a percent of cancer less than 3% in the biopsy specimen, the risk of extraprostatic extension is 11.5%. CONCLUSIONS: The amount of cancer on preoperative needle sextant biopsy is the strongest predictor of prostate stage, but it is slightly practical at the moment of admitting or to reject a patient for radical prostatectomy.

Correlación del estadio anatomopatológico de la pieza de prostatectomía radical con la cantidad de cáncer en la biopsia sextante preoperatoria / The pathological correlation of radical prostatectomy specimen with the quantification of the amount of cancer on preoperative needle sextant biopsy

OBJETIVO: Analizamos la utilidad que tiene la estimación del porcentaje de cáncer en la biopsia sextante para predecir el riesgo de extensión extraprostática en la pieza de prostatectomía radical retropúbica. MATERIAL Y MÉTODOS: Revisamos los hallazgos en las biopsias preoperatorias de 97 pacientes con cáncer de próstata T1c-T2c a los que se le practicó prostatectomía radical retropúbica. En cada biopsia se evalúa el número de cilindros positivos, el porcentaje de cilindros positivos, el porcentaje de cáncer en todos los cilindros, el Gleason, la presencia de neoplasia intraepitelial, la invasión perineural y la invasión vascular. A los resultados de la biopsia se añade el PSA preoperatorio y el estadio clínico, para determinar que parámetros pueden determinar mejor el estadio anatomopatológico, con un análisis univariante y multivariante. RESULTADOS: De los 97 pacientes, 72 (74 por ciento) tenían cáncer organoconfinado y 25 (26 por ciento) presentaban extensión extraprostática del cáncer. El número medio de cilindros positivos en los cánceres organoconfinados fue de 4,2 (mediana 4) vs. 6,8 (mediana 6) para los cánceres con extensión extraprostática (p=0,001). El porcentaje medio de cilindros positivos en los cánceres organoconfinados fue de 34,9 por ciento (mediana 28) vs. 53,8 por ciento (mediana 46) para los cánceres con extensión extraprostática (p=0,013). El porcentaje medio de cáncer en todo el material de la biopsia del cáncer organoconfinado fue de 13,6 por ciento (mediana 6) vs. 30,5 por ciento (mediana 30) para los cánceres con extensión extraprostática (p=0,002). Los valores medios de la puntuación de Gleason eran de 5,9 (mediana 6) en las biopsias de los cánceres organoconfinados vs. 6,6 (mediana 7) en los que presentaban extensión extraprostática (p=0,007). Se observó neoplasia intraepitelial en 3 (4 por ciento) de los cánceres organoconfinados vs. 1 (4 por ciento) de los cánceres con extensión extraprostática (p=0,972). Se encontró invasión perineural en 6 (8,3 por ciento) de las biopsias de los cánceres organoconfinados vs. 4 (16 por ciento) de los cánceres con invasión extraprostática (p=0,355). El análisis univariante demuestra que el riesgo de extensión extraprostática está en relación con el número de cilindros positivos (p=0,003), porcentaje de cilindros positivos (p=0,006), el porcentaje de cáncer en toda la biopsia (p=0,001), el Gleason (p=0,002), el estadio clínico (p=0,019) y el PSA preoperatorio (p=0,032). La presencia de neoplasia intraepitelial (p=0,971), infiltración vascular o infiltración perineural (p=0,285), no predice la extensión extraprostática. En el análisis multivariante se demuestra que el porcentaje de cáncer en el material de la biopsia es la variable que mejor predice la extensión extraprostática del cáncer (p=0,035). Con un porcentaje de cáncer inferior al 3 por ciento en la biopsia, la probabilidad de extensión extraprostática es solamente del 11,5 por ciento. CONCLUSIONES: El porcentaje de cáncer en la biopsia sextante preoperatoria es la variable que mejor predice el estadio del cáncer de próstata, pero es poco práctica a la hora de admitir o desechar un paciente para prostatectomía radical (AU)

OBJETIVE: We assess the value of the percent of cancer in needle cores of sextant biopsy for predicting the risk of extraprostatic extension at radical retropubic prostatectomy. MATERIAL AND METHODS: We reviewed prostate needle biopsy findings in 97 patients with prostate cancer T1c-T2, who subsequently underwent radical retropubic prostatectomy. In each needle biopsy were assessed, number of cores positive, percent of cores positive, percent cancer in all cores, Gleason score, intraepithelial neoplasia, perineural invasion and vascular invasion. Initial PSA and preoperative clinical stage were incorporated with biopsy results into a univariate and multivariate model to determine the parameters most predictive of pathological stage. RESULTS: Of the 97 patients, 72 (74%) had organ confined cancer and 25 (26%) had extraprostatic extension. The average of cores positive for organ confined cancer was 4.2 (median 4) vs. 6.9 (median 6) for extraprostatic extension (p=0.001), the percent of cores positive for organ confined cancer was 34.9% (median 28) vs. 53.8% (median 46) for extraprostatic extension (p=0.013). The average of cancer in all cores in organ confined cancer was 13.6% (median 6) vs. 30.5% (median 30) for extraprostatic extension (p=0.002). The mean Gleason score in needle cores was 5.9 (median 6) in organ confined cancer vs. 6.6 (median 7) in extraprostatic extension (p=0.007). The average of intraepithelial neoplasia in needle cores was 3 (4%) in organ confined cancer vs. 1 (4%) in extraprostatic extension (p=0,972). The perineural invasion of needle cores was 6 (8.3%) in confined cancer vs. 4 (16%) in extraprostatic extension (p=0.355). Univariate analysis demostrated that the risk of extraprostatic extension is predicted by the number of cores positive (p=0.003), the percent of cores positive (p=0.006), the percent of cancer in all cores (p=0.001), the Gleason score (p=0.002), the clinical stage (p=0.019) and initial PSA (p=0.032). Extraprostatic extension is not predicted by the intraepithelial neoplasia (p=0.971), vascular invasion and perineural invasion (p=0.285). Multivariate analysis showed that the percent of cancer in all cores is the strongest predictor of extraprostatic extension (p=0.035). With a percent of cancer less than 3% in the biopsy specimen, the risk of extraprostatic extension is 11.5%. CONCLUSIONS: The amount of cancer on preoperative needle sextant biopsy is the strongest predictor of prostate stage, but it is slightly practical at the moment of admitting or to reject a patient for radical prostatectomy (AU)

[Mucinous adenocarcinoma of the urachus]. / Adenocarcinoma mucinoso de uraco.

OBJECTIVE: The Adenocarcinoma of the Urachus is very rare tumor, with an incidence of 1/5,000,000 inhabitants, represents less than 0.001 of all types of bladder cancer. CASE REPORT: A 51 year old man with a chronic history of suprapubic pain and hematuria. Physical examination and excretory urography were normal. The cystoscopy demonstrated a oedematosa area in cupola of bladder wall. The transuretral biopsy was moderately differentiated adenocarcinoma, with positive antibody to CK7 and CK20, the carcinoembryonic antigen was 6.6 ng/ml. Extended partial cystectomy was done, followed for chemotherapy and radiotherapy. CONCLUSIONS: The treatment of adenocarcinoma of the urachus with a combination of extended partial cystectomy, chemotherapy and radiation, is a effective treatment.

Adenocarcinoma mucinoso de uraco / Mucinous adenocarcinoma of the urachus

OBJETIVO: El adenocarcinoma de uraco es un tumor extremadamente raro, con una incidencia de 1/5.000.000 de habitantes, lo que representa menos del 0,001 de todos los tumores de vejiga. CASO CLÍNICO: Varón de 51 años con historia de dolor suprapúbico y hematuria. La exploración física y la urografía intravenosa eran normales. La cistoscopia demostraba un área edematosa en la cúpula de la vejiga. La biopsia transuretral confirmó un adenocarcinoma moderadamente diferenciado, con anticuerpos positivos CK7 y CK20. El antígeno carcinoembrionario era de 6,6. Se practicó cistectomía parcial extensa, seguida de quimioterapia y radioterapia. CONCLUSIONES: El tratamiento del adenocarcinoma de uraco con una combinación de cistectomía parcial extensa, quimioterapia y radioterapia es eficaz. (AU)