Fibrosarcoma de cordón espermático en estadío avanzado / Advanced stage fibrosarcoma of the spermatic cord

No disponible

Complicación de sustitución ureteral bilateral mediante plastia de íleon / Complication of a bilateral ileal ureteral replacement

No disponible

[Synchronous metastases of the spermatic cord from papillary renal cell carcinoma]. / Carcinoma renal papilar con metástasis sincr6nica en el cordón espermático.

Papillary renal cell carcinoma has been related with higher survival rate and lower metastatic cancer mortality rate than clear renal cell carcinoma. We present an aggressive case related to unusual features for this histological type, like a tumor size higher than ten cm, great perirrenal fat and suprarenal gland infiltration, tumoral thrombosis of the infrahepatic cava vein, retroperitoneal adenopatic tumoral infiltration, high nuclear grade and synchronous solitary distant organ metastases of the right spermatic cord, finding three previous cases in the literature with this last feature. Prognostic implication of the papillary renal cell carcinoma type is unclear in cases like this, so probably we need better molecular and cytogenetic studies to get a correct classification of this histological type.

Carcinoma renal papilar con metástasis sincrónica en el cordón espermático / Synchronous metastases of the spermatic cord from papillary renal cell carcinoma

El carcinoma de células renales papilar (CCRP) se ha relacionado con porcentajes de supervivencia superiores y tasas de mortalidad por cáncer metastático inferiores respecto al carcinoma de células renales convencional. Presentamos un caso de comportamiento agresivo de acuerdo a la suma de características infrecuentes para esta variante histológica, como el tamaño tumoral superior a 10 cm, la infiltración severa de la grasa perirrenal y de la glándula suprarrenal homolateral, la trombosis tumoral de la vena renal y de la vena cava infradiafragmática, la afectación adenopática retroperitoneal, un alto grado nuclear y la asociación en el momento del diagnóstico de una metástasis a distancia única sincrónica en el cordón espermático derecho, habiéndose comunicado esta última circunstancia en tres casos previos. La diferenciación pronóstica de la variante papilar resulta controvertida ante casos de este tipo, planteando la necesidad de obtener mejores perfiles diferenciales citogenéticos y moleculares para la clasificación de esta entidad histológica

Papillary renal cell carcinoma has been related with higher survival rate and lower metastatic cancer mortality rate than clear renal cell carcinoma. We present an aggressive case related to unusual features for this histological type, like a tumor size higher than ten cm, great perirrenal fat and suprarenal gland infiltration, tumoral thrombosis of the infrahepatic cava vein, retroperitoneal adenopatic tumoral infiltration, high nuclear grade and synchronous solitary distant organ metastases of the right spermatic cord, finding three previous cases in the literature with this last feature. Prognostic implication of the papillary renal cell carcinoma type is unclear in cases like this, so probably we need better molecular and cytogenetic studies to get a correct classification of this histological type

[Traumatic rupture of a horseshoe kidney]. / Rotura traumática de riñón en herradura.

One-third to one-half of all patients with horseshoe kidney are asymptomatic and the condition is found incidentally. This congenital renal anomaly has shown as a predisponent condition for renal injury in blunt abdominal trauma, but often the degree of injury has a nonoperative therapy. Horseshoe kidney rupture is an exceptional pathology that require a complete diagnostic study to make an adequate management when surgical therapy is indicated. We present a fifteen-year-old male with previously unsuspected horseshoe kidney that suffered an atypical right upper-pole and mesorrenal kidney rupture after low-velocity-impact blunt abdominal trauma. A correct presurgical diagnose let a deferred surgical approach with right lower pole and horseshoe renal isthmus preservation. The trauma conditions, an excesive clinic manifestation, a clinical investigation about known congenital simultaneous anomallies and typical radiological signs, can suggest this infrequent patology. Computed tomography provides the best radiological information.

Rotura traumática de riñón en herradura / Traumatic fracture of a horseshoe kidney

Entre un tercio y la mitad de los riñones en herradura son asintomáticos y se diagnostican incidentalmente. Esta anomalía congénita de fusión se ha mostrado como condición predisponente a la lesión renalante un traumatismo abdominal, aunque con frecuencia el grado de afectación renal no precise cirugía. Más excepcional es el hallazgo de fractura de riñón en herradura, requiriéndose un estudio diagnóstico completo para un manejo adecuado a sus características cuando la cirugía está indicada. Se aporta el caso de un varón de 15 años con riñón en herradura no previamente conocido, que presentó una fractura de localización atípica polar superior y mesorrenal derecha, tras un traumatismo abdominal de baja intensidad. El correcto diagnóstico prequirúrgico permitió una cirugía diferida con preservación del polo renal inferior derecho y del istmo del riñón en herradura. Las características del trauma, la desproporción de la repercusión clínica y la búsqueda de posibles anomalías congénitas asociadas y de signos radiológicos compatibles, pueden orientar esta rara posibilidad diagnóstica, confirmándose el TAC con contraste como la mejor prueba de imagen

One-third to one-half of all patients with horseshoe kidney are asymptomatic and the condition is found incidentally. This congenital renal anomaly has shown as a predisponent condition for renal injury in blunt abdominal trauma, but often the degree of injury has a non operative therapy. Horseshoe kidney rupture is an exceptional pathology that require a complete diagnostic study to make an adequate management when surgical therapy is indicated. We present a fifteen year-old-male with previously unsuspected horseshoe kidney that suffered an atipicright upper-pole and mesorrenal kidney fracture after low velocity impact blunt abdominal trauma. A correct presurgical diagnose let a deferred surgical approach with rigth lower pole and horseshoe renal isthmus preservation. The trauma conditions, an excesive clinic manifestation, a clinical investigation about known congenital simultaneous anomallies and typical radiological signs, can suggest this infrequent patology. Computed tomography provide the best radiological information

[Cystic testicular lesions in infancy]. / Lesiones quísticas testiculares en la infancia.

The present article reports a case 11 month-old infant with a right intratesticular cyst. We analyze the etiology, differential diagnosis and management off all cystic lesions of the pediatric testis. Patient age at presentation, examination features, tumor markers and sonographic appearance may assist in making a presumptive and occasionally definitive diagnosis preoperatively. The differential diagnosis include intratesticular simple cyst, epidermoid cyst, tunica albuginea cyst, testicular teratoma, juvenil granulosa cell tumor-gonadal stromal tumor, cystic dysplasia of the rete testis, cystic lymphangioma, and testicular torsion. Usually enucleation is the best treatment. A thorough understanding of potentially cystic testis lesions in children leads to the best management choices and often to preservation of a substantial portion of the affected testis.

Agenesia renal derecha y abocamiento ectópico del uréter en dilatación quística de la vesícula seminal / Right renal agenesis and ureter ectopic abouchement in cystic dilation of seminal vesicle

La asociación de una dilatación quística de la vesícula seminal con agenesia renal ipsilateral, fue descrita por primera vez por Zinner en 1914, constituyendo una anomalía congénita muy poco frecuente. La presencia añadida de la desembocadura ectópica del uréter en dicha vesícula seminal quística resulta aún más excepcional. En estas circunstancias, la clínica suele presentarse a partir de los 15 años de edad, debido a la distensión de la vesícula por las secreciones seminales, siendo el disconfort perineal y las epididimitis de repetición las formas de presentación más frecuentes. Ante el hallazgo clínico-radiológico de una masa quística pélvica, es obligada la revisión del tracto urinario superior. La resonancia magnética (RM) se muestra como la mejor técnica de imagen para este objetivo, así como para precisar la localización del abocamiento ectópico ureteral en la vesícula seminal. Aportamos un nuevo caso de esta infrecuente malformación congénita en el que únicamente la RM entre todas las pruebas de imagen, permitió un claro diagnóstico preoperatorio y una adecuada planificación quirúrgica

The association of a seminal vesicle cyst with ipsilateral renal agenesis was initially reported in 1914 by Zinner, and it is a very rare congenital anomaly. The association of this anomaly with an ectopic ureter entering the seminal vesicle cyst is even less common. In these cases, clinical symptoms appear in patients 15 years or older due to the distention of the seminal vesicle caused by the secretions of the reproductive tract. Perineal discomfort and recurrent epididymitis are the most often presentations. Urogenital upper tract image studies are mandatory in the management of a cystic pelvic mass and magnetic resonance imaging (MRI) is the best of this radiographic studies, that also reveals the ectopic ureter draining into the seminal vesicle. We report an additional case of this rare congenital anomaly where only MRI provided a correct preoperative diagnosis and a right surgical approach

[Adult Wilms' tumor]. / Tumor de Wilms del adulto.

Wilms' tumor is a malignant embryonic renal neoplasm that is exceptional in adults. There are not clinical data or radiographic investigations that can distinguish it from renal cell carcinoma. So the diagnostic is based in the pathological evaluation. It may be cystic and must be consider in the differential diagnosis of cystic lesions of the kidney. The prognosis of Wilms' tumor in adults is worse than in children because of the high recurrence, the lower response rate to chemotherapy regimens and the advanced stage at the time of clinical presentation, like an asymptomatic abdominal mass in 75% of the cases. We report a new case of nephroblastoma in a 29 years old woman presenting like a renal colic, with a cystic configuration by abdominal ultrasound initially, that changed into a solid renal mass later. There is not a definitive treatment protocol currently but some authors suggest a combination chemotherapy with carboplatin and etoposide because it is very effective in recurrent or refractory adult Wilms' tumor. Our patient remains asymptomatic and without evidence of recurrence 18 months after the surgery.

Lesiones quísticas testiculares en la infancia / Cystic testicular lesions in infancy

Presentamos el caso de un niño de 11 meses diagnosticado de quiste intratesticular derecho. Analizamos la etiología, el diagnóstico diferencial y el manejo de las lesiones quísticas testiculares en la infancia. La edad del paciente, la exploración física, los marcadores tumorales y los hallazgos ecográficos contribuyen a la sospecha diagnóstica y en ocasiones al diagnóstico definitivo preoperatoriamente. El diagnóstico diferencial incluye el quiste simple, el quiste epidermoide, los quistes de túnica albuginea, el teratoma testicular, el tumor de células granulosa juvenil-tumor del estroma gonadal, la displasia quística de la rete testis, el linfangioma quístico y la torsión testicular. La enucleación es habitualmente el tratamiento de elección. El conocimiento de las lesiones quísticas testiculares en la infancia permite un adecuado manejo de las mismas y un tratamiento más conservador

The present article reports a case 11 month- old infant with a right intratesticular cyst. We analyze the etiology, differential diagnosis and management off all cystic lesions of the pediatric testis. Patient age at presentation, examination features, tumor markers and sonographic appearance may assist in making a presumptive and occasionally definitive diagnosis preoperatively. The differential diagnosis include intratesticular simple cyst, epidermoid cyst, tunica albuginea cyst, testicular teratoma, juvenil granulosa cell tumor-gonadal stromal tumor, cystic dysplasia of the rete testis, cystic lymphangioma, and testicular torsion Ussually enucleation is the best treatment. A thorough understanding of potentially cystic testis lesions in children leads to the best management choices and often to preservation of a substantial portion of the affected testis

Tumor de Wilms del adulto / Adult Wilms’ tumor

El tumor de Wilms es una neoplasia renal maligna de origen embrionario de aparición excepcional en la edad adulta. Clínica y radiológicamente resulta indistinguible del carcinoma de células renales, por lo que su diagnóstico es anatomopatológico. Su estructura puede ser quística y debe ser considerado en el diagnóstico diferencial de la lesión quística renal. El pronóstico en el adulto es peor que en la edad pediátrica debido a la mayor incidencia de recurrencia tumoral, a la falta de respuesta a los quimioterápicos clásicos utilizados tras la exéresis quirúrgica en niños y al estadío avanzado en el momento de la presentación clínica, como hallazgo casual de una masa abdominal asintomática en el 75% de los casos. Presentamos un nuevo caso de nefroblastoma del adulto en una mujer de 29 años, que debutó clínicamente como cólico nefrítico, con una configuración inicial ecográfica de masa renal quística con posterior evolución a lesión sólida.Se carece por el momento de guías de tratamiento quimioterápico post-operatorio establecidas, pero algunos autores sugieren el empleo de carboplatino y etopósido debido a su comprobada eficacia en tumor de Wilms recurrente o refractario. Tras la administración de dichos fármacos, nuestra paciente permanece asintomática y sin recidiva tumoral 18 meses después de la cirugía

Wilms’ tumor is a malignant embryonic renal neoplasm that is exceptional in adults. There arenot clinical data or radiographic investigations that can distinguish it from renal cell carcinoma. Sothe diagnostic is based in the pathological evaluation. It may be cystic and must be consider in thedifferential diagnosis of cystic lesions of the kidney.The prognosis of Wilms’ tumor in adults is worse than in children because of the high recurrence,the lower response rate to chemotherapy regimens and the advanced stage at the time of clinical presentation,like an asymptomatic abdominal mass in 75% of the cases.We report a new case of nephroblastoma in a 29 years old woman presenting like a renal colic,with a cystic configuration by abdominal ultrasound initially, that changed into a solid renal masslater. There is not a definitive treatment protocol currently but some authors suggest a combinationchemotherapy with carboplatin and etoposide because it is very effective in recurrent or refractoryadult Wilms’ tumor.Our patient remains asymptomatic and without evidence of recurrence 18 months after thesurgery

[Intrascrotal metastasis in a renal cell carcinoma]. / Metástasis intraescrotal de un carcinoma renal.

The present article reports a case of intrascrotal metastasis of renal adenocarcinoma. This is an unusual case. A 66-year-old male patient undewent right radical nephrectomy and cavotomy for renal cell carcinoma with renal vein infiltration and thrombus in cava. Six months later the patient present with a nodulous enlargement intrascrotal and roots of penis. And he died 15 moths after nephrectomy. Usually intrascrotal metastases are a late event in the course after detection of a renal carcinoma.

Metástasis intraescrotal de un carcinoma renal / Intrascrotal metastasis in a renal cell carcinoma

Comunicamos un caso, infrecuente, de metástasis intraescrotal de un carcinoma renal. Se trata de un paciente varón de 66 años, sometido a nefrectomía radical con cavotomía por un carcinoma de células renales con infiltración en la vena renal y trombo en cava. Seis meses después, consultó por la aparición de unos nódulos intraescrotales y en raíz de pene. El paciente falleció 15 meses después de la nefrectomía. Habitualmente las metástasis intraescrotales son un evento tardío después de la detección del carcinoma renal (AU)

The present article reports a case of intrascrotal metastasis of renal adenocarcinoma. This is an unusual case. A 66-year-old male patient undewent right radical nephrectomy and cavotomy for rena lcell carcinoma with renal vein infiltration and thrombus in cava. Six months later the patient present with a nodulous enlargement intrascrotal and roots of penis. And he died 15 moths after nephrectomy. Usually intrascrotal metastases are a late event in the course after detection of a renal carcinoma (AU)

[Right renal agenesis and ureter ectopic abouchement in cystic dilation of seminal vesicle]. / Agenesia renal derecha y abocamiento ectópico del uréter en dilatación quística de la vesícula seminal.

The association of a seminal vesicle cyst with ipsilateral renal agenesis was initially reported in 1914 by Zinner, and it is a very rare congenital anomaly. The association of this anomaly with an ectopic ureter entering the seminal vesicle cyst is even less common. In these cases, clinical symptoms appear in patients 15 years or older due to the distention of the seminal vesicle caused by the secretions of the reproductive tract. Perineal discomfort and recurrent epididymitis are the most often presentations. Urogenital upper tract image studies are mandatory in the management of a cystic pelvic mass and magnetic resonance imaging (MRI) is the best of this radiographic studies, that also reveals the ectopic ureter draining into the seminal vesicle. We report an additional case of this rare congenital anomaly where only MRI provided a correct preoperative diagnosis and a right surgical approach.

[Giant retroperitoneal liposarcoma]. / Liposarcoma retroperitoneal gigante.

Liposarcoma is a malignant tumor that has an embryologic origin from mesodermal tissue depending on fatty tissue. Although liposarcoma is only 0.1% of all human neoplasms, it is the most common histology subtype of retroperitoneal soft tissue sarcomas. This tumor grows slowly. Diffuse abdominal pain is its most frequent symptom and abdominal mass is the most common sign. Aggressive surgical treatment is basic to get a complete resection and a local disease control. This objective is difficult because of the large tumor size it gets in the retroperitoneal location and the multiorgan involvement that require the resection of a high percentage of contiguous organs. We report a case of a giant retroperitoneal liposarcoma presenting like continuous left hemiabdominal pain because of the visceral compression. The right kidney was involved and suffering from renal vessel enlargement without renal function. There is a high probability of microscopic residual disease and a good follow-up of the patients is necessary as well as an adjuvant radiation therapy in some cases.

[Primary renal lymphoma]. / Linfoma renal primario.

OBJECTIVE: To describe a case of primary renal lymphoma. MATERIAL AND METHODS: We presents a patient with a right renal mass which histological analysis revealed a non-Hodgkin Lymphoma. RESULTS: A 78-year-old male patient with right flank pain mass was referred to our Service. He was diagnosed of renal mass by imaging studies. Inmunohistochemical investigations revealed a B-cell-type lymphoma. He received combination chemotherapy with CHOP. CONCLUSIONS: Primary renal lymphoma is a rare disease whose existence has been questioned, because the kidney does not normally contain lymphoid tissue. Its clinical presentation is like any other renal tumor and its definitive diagnosis is by histology. Elective treatment is chemotherapy (CHOP).

Linfoma renal primario / Primary renal lymphoma

OBJETIVO: Presentar un caso de linfoma renal primario. MATERIAL Y MÉTODOS: Estudiamos el caso clínico de un paciente en el que se descubrió una masa renal, con el diagnóstico anatomopatológico de linfoma renal primario. RESULTADOS: Se trata de un paciente de 78 años de edad que acudió a nuestra consulta por dolor en fosa renal derecha. Al realizar varias pruebas complementarias se llegó al diagnóstico de masa renal derecha, cuyo estudio anatomopatológico tras punción-biopsia reveló un linfoma difuso de células B, siendo tratado con ciclos de quimioterapia sistémica según la pauta CHOP. CONCLUSIONES: El linfoma renal primario es una entidad rara y cuestionada por muchos autores. En la práctica clínica se presenta de modo similar al resto de tumores renales, por lo que su diagnóstico debe ser histológico. El tratamiento de elección es la quimioterapia sistémica con la combinación CHOP (AU)

[Traumatic intrathoracic herniation of the left kidney]. / Herniación intratorácica traumática del riñón izquierdo.

The detection of a intrathoracic kidney is an exceptional discovery. There is a large period of time between the injury and its clinical presentation revising the literature, so it is possible that the herniation of the kidney into the chest was caused by a rise in intra-abdominal pressure but going through a preexistent congenital way not caused by the traumatism. In order to dismiss this possibility and to prove the traumatic origin of the diaphragmatic rupture, surgeons have examined the intraoperative characteristics of the rupture's borders. The elevation of the kidney has been said to be progressive because of the positive intra-thoracic pressure and the negative intra-abdominal one. Our objective is to report an extraordinary case of abdominal traumatism whose clinic and radiological proofs let us get a rapid diagnosis and surgical demonstration of the direct herniation of the left kidney into the chest through a diaphragmatic rupture caused by the same traumatism.

Herniación intratorácica traumática del riñón izquierdo / Intrathoracic traumatic herniation of the left kidney

La aparición de un riñón intratorácico como consecuencia de un traumatismo es un hallazgo excepcional. En la revisión de otros casos publicados en la literatura hay habitualmente un dilatado periodo de latencia hasta la manifestación clínica del proceso, por lo que se planteaba la posibilidad de que el incremento de la presión abdominal fuera únicamente el causante del ascenso hacia el tórax del riñón, a través de un trayecto congénito previamente existente y no causado por el traumatismo. Para descartar esta posibilidad y demostrar el origen traumático de la brecha diafragmática se ha recurrido al examen intraoperatorio de las características de los bordes del orificio herniario. Así mismo se ha sugerido que el ascenso del riñón sea progresivo en el tiempo, como consecuencia de la presión positiva abdominal y negativa intratorácica. Nuestro objetivo es presentar un caso extraordinario de traumatismo abdominal en el que la clínica y el estudio radiológico permitieron un diagnóstico inmediato y la constatación quirúrgica del ascenso directo del riñón izquierdo al tórax a través de un orificio herniario diafragmático de nueva adquisición como consecuencia del propio traumatismo (AU)

The detection of a intrathoracic kidney is an exceptional discovery. There is a large period of time between the injury and its clinical presentation revising the literature, so it is possible that the herniation of the kidney into the chest was caused by a rise in intra-abdominal pressure but going through a preexistent congenital way not caused by the traumatism. In order to dismiss this possibility and to prove the traumatic origin of the diaphragmatic rupture, surgeons have examinated the intraoperative characteristics of the rupture's borders. The elevation of the kidney has been said to be progressive because of the possitive intra-thoracic pressure and the negative intra-abdominal one. Our objetive is to report an extraordinary case of abdominal traumatism whose clinic and radiological proofs let us get a rapid diagnosis and surgical demonstration of the direct herniation of the left kidney into the chest through a diaphragmatic rupture caused by the same traumatism (AU)

[Intra-sinusal renal angiomyolipoma. Differential diagnosis from renal artery aneurysm]. / Angiomiolipoma renal intrasinusal. Diagnóstico diferencial con el aneurisma de arteria renal.

We report a case of atypical renal angiomyolipoma (AML) because of its clinic presentation like colic renal pain, its uncommon intrasinusal location, its low fatty content, and especially because of the diagnostic doubt with a renal artery aneurysm that could not be resolved before the surgery in spite of making Doppler ultrasound, renal one sided arteriography, computed tomography (CT) and magnetic resonance imaging (MRI). We gave up doing a percutaneous needle biopsy because of the location, the association with hematoma and the possibility of a vascular origin. It has been said that diagnostic images, mainly ultrasound and CT, have a high capacity to get a renal AML diagnosis before the surgery. However when there is an atypical characteristics association like we have talked about, dismissing other pathologies is necessary. We believe AML must be considered one of these because of its difficult differential diagnosis.