Multilocular cystic nephroma: A clinical case.

OBJECTIVE: To describe the clinical presentation, preoperative diagnostic possibilities, and treatment of cystic nephroma. METHODS: We describe a case of cystic nephroma in an adult male and show that, both in our patient and in the literature, a definitive diagnosis can only be obtained postoperatively, even when there is a reasonable clinical suspicion. CONCLUSIONS: Cystic nephroma is rare, and some authors consider it a questionable entity. However, it should be distinguished from renal cystic neoplasms, which can resemble the condition.

Nefroma quístico multilocular: a propósito de un caso / Multilocular cystic nephroma: A clinical case

OBJETIVO: Mostrar la presentación clínica, las posibilidades diagnosticas preoperatorias y el tratamiento del nefroma quístico. MÉTODOS: Se presenta un caso de nefroma quístico en un varón adulto, comprobando en nuestro caso y en la revisión de la literatura que aunque exista una razonable sospecha clínica, el diagnóstico cierto solo es posible postcirugía. CONCLUSIONES: El nefroma quístico es de frecuencia escasa y por algunos autores es considerada una entidad dudosa, pero hay que tratar de distinguirla de neoplasias quísticas renales, que pueden simular este proceso

OBJECTIVE: To describe the clinical presentation, preoperative diagnostic possibilities, and treatment of cystic nephroma.METHODS: We describe a case of cystic nephroma in an adult male and show that, both in our patient and in the literature, a definitive diagnosis can only be obtained postoperatively, even when there is a reasonable clinical suspicion.CONCLUSIONS: Cystic nephroma is rare, and some authors consider it a questionable entity. However, it should be distinguished from renal cystic neoplasms, which can resemble the condition

Paraurethral leiomyoma.

OBJECTIVE: To describe a case of para-urethral leiomyoma and to review the literature. METHODS: The usual preoperative diagnostic procedures and clinical manifestations are discussed. RESULTS: The mass was resected and, 6 years later, the patient remains asymptomatic and with no recurrence. CONCLUSIONS: Urethral or paraurethral leiomyomas are benign tumors that arise from the urethral or vaginal smooth muscle. Radiological findings (particularly magnetic resonance imaging) may suggest the origin of the tumor before surgery; however, the final diagnosis is determined by histology.

Leiomioma parauretral / Paraurethral Leiomyoma

OBJETIVO: Presentar un caso de leiomioma parauretral y revisar la literatura. MÉTODOS: Se comentan los procedimientos diagnósticos preoperatorios más habituales y las manifestaciones clínicas. RESULTADOS: Tras la exéresis de la tumoración la paciente quedó asintomática, y sin recidiva seis años después. CONCLUSIONES: Los leiomiomas uretrales o parauretrales son tumoraciones benignas derivadas del músculo liso uretral o vaginal, siendo posible intuir preoperatoriamente este origen con pruebas radiológicas especialmente con la RMN, aunque el diagnostico definitivo solo es histológico (AU)

OBJECTIVE: To describe a case of para-urethral leiomyoma and to review the literature. METHODS: The usual preoperative diagnostic procedures and clinical manifestations are discussed. RESULTS: The mass was resected and, 6 years later, the patient remains asymptomatic and with no recurrence. CONCLUSIONS: Urethral or paraurethral leiomyomas are benign tumors that arise from the urethral or vaginal smooth muscle. Radiological findings (particularly magnetic resonance imaging) may suggest the origin of the tumor before surgery; however, the final diagnosis is determined by histology (AU)

Neuroendocrine carcinoma of the urinary bladder. 15-year retrospective analysis.

OBJECTIVES: Neuroendocrine tumors (NET) are cancers found in the bronchopulmonary tract, where they were first described in 1926. The tumors are associated with poor prognosis due to their high metastatic potency even after radical treatments associated with other neo- or adjuvant therapies. NET of the urinary bladder is a rare tumor and accounts for 0.5% of bladder tumors. METHODS: The study was designed as an observational, descriptive and retrospective study of 13 patients diagnosed, treated, and followed for NET of the urinary bladder at the Hospital and University Complex of Albacete, Albacete, Spain between 1995 and 2010. RESULTS: The sample was composed of 11 men and 2 women. Mean patient age at the time of diagnosis was 71 (range, 57-88; SD, 6.98) years. T4 (6 patients) was the most common T tumor stage, followed by T2 (5 patients) and T3 (2 patients). In the case of N tumor stage, the most common was N2. In the remaining 3 patients, the degree of lymph node involvement could not be assessed. Six presented distant metastasis at the time of diagnosis. Eleven patients presented small-cell NET on histology. Seven underwent radical surgery (radical cystectomy). All other patients were treated by deep transurethral resection of bladder tumor, except for 1 patient treated by partial cystectomy. Adjuvant chemo-therapy (usually an association of carboplatin/cisplatin and etoposide) was administered to 4 patients. Of these 4 patients, 2 were also treated by pelvic radiotherapy. Two patients survived more than 5 years following diagnosis. In fact, at the time the study data was collected only 4 patients had survived and 2 presented tumor recurrence. Of the 9 deaths, 8 occurred within 6 months of diagnosis and 1 at 24 months. All of them were the result of the disease itself. CONCLUSIONS: Neuroendocrine tumor of the urinary bladder is a rare, aggressive tumor with high metastatic potential that should be considered in the differential diagnosis of urinary bladder neoplasms. Despite various multimodality treatments have been used prognosis is poor.

Carcinoma neuroendocrino de vejiga. Analisis retrospectivo de 15 años / Neuroendocrine carcinoma of the urinary bladder. 15-year retrospective analysis

OBJETIVO: Los tumores neuroendocrinos (TNE) son tumores propios del árbol broncopulmonar, donde fueron descritos por primera vez en 1926. Son tumores de mal pronóstico debido a su gran poder metastásico aun después de tratamientos radicales asociados a otras terapias neo o adyuvantes. El TNE de vejiga representa el 0,5% de los tumores vesicales. MÉTODOS: Estudio observacional, descriptivo y retrospectivo de 13 pacientes diagnosticados, tratados y controlados por carcinoma neuroendocrino de vejiga en el Complejo Hospitalario Universitario de Albacete por el periodo entre los años 1995 y 2010. RESULTADOS: La muestra estaba formada por 11 hombres y 2 mujeres. La edad media fue de 71 años. El estadio tumoral T más frecuente hallado fue T4. El estadio tumoral N más frecuente hallado fue N2 . Seis pacientes presentaron metástasis a distancia en el momento del diagnóstico. Once pacientes presentaron histológicamente TNE de células pequeñas. A 7 pacientes se les realizó cirugía radical (cistectomía radical). La quimioterapia adyuvante se administró a 4 pacientes basada principalmente en la asociación de carboplatino/cisplatino y etopósido. A 2 de estos 4 pacientes se les administró radioterapia pélvica complementaria. La Mediana de supervivencia hallada fue de 5,1 meses. Dos pacientes presentaron supervivencia por encima de 5 años tras el diagnóstico. De los 9 éxitus letalis acontecidos, 8 de ellos se produjeron en los primeros 6 meses después del diagnóstico. El caso restante falleció a los 24 meses. Todas estas muertes fueron debidas a la propia enfermedad. CONCLUSIONES: El carcinoma neuroendocrino de vejiga es un tumor infrecuente, agresivo y con alto potencial metastásico que debe ser tenido en cuenta a la hora de realizar el diagnóstico diferencial en las neoplasias de vejiga. A pesar de utilizar distintos tratamientos multimodales el pronóstico es infausto(AU)

OBJECTIVES: Neuroendocrine tumors (NET) are cancers found in the bronchopulmonary tract, where they were first described in 1926. The tumors are associated with poor prognosis due to their high metastatic potency even after radical treatments associated with other neo- or adjuvant therapies. NET of the urinary bladder is a rare tumor and accounts for 0.5% of bladder tumors. METHODS: The study was designed as an observational, descriptive and retrospective study of 13 patients diagnosed, treated, and followed for NET of the urinary bladder at the Hospital and University Complex of Albacete, Albacete, Spain between 1995 and 2010. RESULTS: The sample was composed of 11 men and 2 women. Mean patient age at the time of diagnosis was 71 (range, 57-88; SD, 6.98) years. T4 (6 patients) was the most common T tumor stage, followed by T2 (5 patients) and T3 (2 patients). In the case of N tumor stage, the most common was N2. In the remaining 3 patients, the degree of lymph node involvement could not be assessed. Six presented distant metastasis at the time of diagnosis. Eleven patients presented small-cell NET on histology. Seven underwent radical surgery (radical cystectomy). All other patients were treated by deep transurethral resection of bladder tumor, except for 1 patient treated by partial cystectomy. Adjuvant chemo-therapy (usually an association of carboplatin/cisplatin and etoposide) was administered to 4 patients. Of these 4 patients, 2 were also treated by pelvic radiotherapy. Two patients survived more than 5 years following diagnosis. In fact, at the time the study data was collected only 4 patients had survived and 2 presented tumor recurrence. Of the 9 deaths, 8 occurred within 6 months of diagnosis and 1 at 24 months. All of them were the result of the disease itself(AU)

Cuerpo extraño intravesical / Bladder foreign body

No disponible

46,XX T testicular disorder of sex development. Case report.

OBJECTIVE: We present a case of X-Y translocation with male phenotype (46,XX testicular disorder of sex development) and review the literature. METHODS: Disorders of sex development with mismatch of genetic, gonadal and phenotypic sex are quite rare, and some are due to genetic or chromosomal abnormalities. The karyotype was investigated by a cytogenetic study of peripheral blood (phytohemagglutinin-timulated lymphocyte culture over 72 hours). G-banding analysis of 25 metaphases showed a 46,XX chromosome constitution (46 chromosomes with XX sexual composition). Fluorescence in situ hybridization (FISH) analysis with probes for X centromeres and the sex-determining region of the Y chromosome (SRY) (testis-determining factor gene) showed two X chromosomes. The analysis also showed the SRY signal in the telomeric region of the short arm of one of the chromosomes. RESULTS: In recent years, a number of other genes involved in disorders of sex development in animals and humans have also been identified. Genetic defects in the peptide hormone receptors, members of the steroid receptor superfamily, and other transcription factors, as well as any of a series of enzymes and cofactors involved in steroid biosynthesis can cause abnormal determination and differentiation. CONCLUSIONS: Although chromosomal abnormalities are rarely present in patients with apparently normal external genitalia, they should be considered in urology consultations by adolescents and adults, particularly in the investigation of gynecomastia or infertility.

46, XX testicular DSD. Aportación de un caso / 46, XX testicular disorder of sex development. Case report

OBJETIVO: Presentamos un caso de translocación entre cromosomas X e Y, con fenotipo masculino (46,XX testicular DSD) y revisamos la literatura.MÉTODOS: Los trastornos de la diferenciación sexual en los que no hay correspondencia entre los sexos genético, gonadal y fenotípico son relativamente infrecuentes, algunos son debidos a alteraciones genéticas o cromosómicas.Se efectuó estudio citogenético, realizando cariotipo en sangre periférica (cultivo de linfocitos de 72 horas de duración estimulados por fitohemaglutinina). Las 25 metafases analizadas con bandas G muestran una formula cromosómica de 46,XX (46 cromosomas con formula sexual XX). Tras realizar FISH (hibridación “in situ” fluorescente) con sondas para centrómero de X y región SRY(gen determinante de testículos) de Y, se observan dos cromosomas X, y en la región telomérica del brazo corto de uno de ellos la señal para SRY.RESULTADOS: En los últimos años se han identificado varios genes a parte del SRY, en animales y en humanos que intervienen en los trastornos de la diferenciación sexual. Los defectos genéticos en los receptores de las hormonas péptidicas, los miembros de la superfamilia de los receptores esteroideos y otros factores de transcripción, así como cualquiera de una serie de enzimas y cofactores que intervienen en la biosíntesis de los esteroides pueden inducir una determinación y una diferenciación anómala.CONCLUSIONES: Aunque son poco frecuentes las alteraciones cromosómicas con genitales externos aparentemente normales, hay que tenerlas en cuenta sobre todo en la consulta de urología de adolescentes y adultos, fundamentalmente en el estudio de ginecomastia o de infertilidad(AU)

OBJECTIVE: We present a case of X-Y translocation with male phenotype (46,XX testicular disorder of sex development) and review the literature.METHODS: Disorders of sex development with mismatch of genetic, gonadal and phenotypic sex are quite rare, and some are due to genetic or chromosomal abnormalities. The karyotype was investigated by a cytogenetic study of peripheral blood (phytohemagglutinin-stimulated lymphocyte culture over 72 hours). G-banding analysis of 25 metaphases showed a 46,XX chromosome constitution (46 chromosomes with XX sexual composition). Fluorescence in situ hybridization (FISH) analysis with probes for X centromeres and the sex-determining region of the Y chromosome (SRY) (testis-determining factor gene) showed two X chromosomes. The analysis also showed the SRY signal in the telomeric region of the short arm of one of the chromosomes.RESULTS: In recent years, a number of other genes involved in disorders of sex development in animals and humans have also been identified.Genetic defects in the peptide hormone receptors, members of the steroid receptor superfamily, and other transcription factors, as well as any of a series of enzymes and cofactors involved in steroid biosynthesis can cause abnormal determination and differentiation.CONCLUSIONS: Although chromosomal abnormalities are rarely present in patients with apparently normal external genitalia, they should be considered in urology consultations by adolescents and adults, particularly in the investigation of gynecomastia or infertility(AU)

Tumor inside an inguinoscrotal bladder hernia.

OBJECTIVE: To describe two cases of urothelial tumors in inguinoscrotal bladder hernias and comment on the low incidence of this condition. METHODS: Two patients were diagnosed and treated by partial cystectomy and hernia repair. RESULTS: The clinical outcome of both patients was good at two and three years, respectively, and neither patient experienced hernia or tumor recurrence. CONCLUSIONS: Inguinal bladder hernias are relatively common. However, few reports of tumor in the herniated bladder have been published. Treatment consists of tumor removal, hernia repair and treatment of any associated urethroprostatic condition.

Tumor en hernia vesical inguinoescrotal / Tumor inside an inguinoscrotal bladder hernia

OBJETIVO: Mostramos dos casos de neoplasia urotelial en hernias vesicales inguinoescrotales y referimos su escasa incidencia.METODOS: Se describe el diagnóstico y tratamiento efectuado con cistectomía parcial y herniorrafia.RESULTADOS: Ambos pacientes al cabo de dos y tres años respectivamente han tenido buena evolución clínica, sin recidiva herniaria ni del tumor.CONCLUSIONES: Las hernias vesicales inguinales son relativamente frecuentes, pero los casos de tumor en la vejiga herniada son escasos en la literatura. El tratamiento persigue eliminar el tumor, reparar la hernia y tratar si existe la patología uretroprostática (AU)

OBJECTIVE: To describe two cases of urothelial tumors in inguinoscrotal bladder hernias and comment on the low incidence of this condition.METHODS: Two patients were diagnosed and treated by partial cystectomy and hernia repair.RESULTS: The clinical outcome of both patients was good at two and three years, respectively, and neither patient experienced hernia or tumor recurrence.CONCLUSIONS: Inguinal bladder hernias are relatively common. However, few reports of tumor in the herniated bladder have been published. Treatment consists of tumor removal, hernia repair and treatment of any associated urethroprostatic condition (AU)

Quistes de rafe medio. Aportacion de dos casos revisión de laliteratura / Median Raphe Cyst. Report of two cases and literature review

OBJETIVOS: Presentar dos casos de quistes de rafe medio, uno de localización peneana y otro perineal.MÉTODO: Se diagnostican y describen dos casos de quiste de rafe medio, a uno se aplicó tratamiento quirúrgico y el segundo no precisó de tratamiento alguno.RESULTADOS: La intervención quirúrgica del paciente operado no tuvo complicaciónes y a los dos años de la misma estaba asintomático y sin recidiva.CONCLUSIÓN: Los quistes de rafe medio son poco frecuentes; es una patología benigna y su etiología no está completamente aclarada. Su tratamiento consiste en la exéresis simple(AU)

OBJECTIVES: To report 2 cases of median raphe cysts, 1 in the penis and the other in the perineum.METHOD: Two cases of median raphe cyst are described; the first was treated by surgery and the second required no treatment.RESULTS: The surgical patient experienced no complications and was asymptomatic with no recurrence at 2 years.CONCLUSIONS: Median raphe cysts are a rare, benign condition of uncertain etiology. Treatment consists on simple excision(AU)

Cuerpos extraños en pene / Penile foreign bodies

OBJETIVO: Mostrar 8 casos de cuerpos extraños en pene.MÉTODOS/RESULTADOS: Realizamos una presentación fundamentalmente visual de variados artilugios o cuerpos extraños de ubicación peneana.CONCLUSIONES: Raramente la existencia de cuerpos extraños peneanos se debe a accidentes. Los cuerpos extraños en pene son colocados por muy diversas razones, destacando principalmente dentro de actividades eróticas o autoeróticas, pudiendo tener consecuencias desde leves, a casos en los que puede acabar en amputación peneana(AU)

OBJECTIVE: To describe 8 cases of penile foreign bodies.METHODS/RESULTS: We provide an essentially visual overview of various objects or foreign bodies affecting the penis.CONCLUSIONS: The presence of penile foreign bodies is rarely due to an accident. These objects are placed for a wide variety of reasons, but primarily for erotic or self-arousal purposes. The consequences of penile foreign bodies can be mild or very severe, resulting in penile amputation(AU)

[Spermatic cord sarcomas: current status and report of four cases]. / Sarcomas de cordón espermático: estado actual y presentación de cuatro casos clínicos.

OBJECTIVE: To study and review spermatic cord sarcomas, including symptoms, diagnosis, and treatment. METHODS/RESULTS: We review the Spanish and international literature and report 4 new cases: 2 patients with well-differentiated spermatic cord liposarcomas (1 treated by simple tumorectomy), 1 patient with liposarcomatous degeneration of a previously excised atypical lipoma, and 1 patient operated for a malignant retroperitoneal fibrous histiocytoma with subsequent local recurrence in the paratesticular region. CONCLUSIONS: Spermatic cord sarcomas are rare entities that usually appear as painless paratesticular mass. They are diagnosed by imaging studies (ultrasound, computed tomography, magnetic resonance) and confirmed by histological examination. Spermatic cord sarcomas are treated surgically; the efficacy of adjuvant treatments such as chemotherapy or radiation therapy is still under debate.

Sarcomas de cordón espermático estado actual y presentación de cuatro casos clínicos / Spermatic cord sarcomas: current status and report of four cases

OBJETIVO: Estudio y revisión de los sarcomas de cordón espermático, de la clínica, diagnóstico y tratamiento de dicha patología.MÉTODOS/ RESULTADOS: Se revisa la literatura nacional e internacional, aportando cuatro nuevos casos: dos liposarcomas de cordón espermático bien diferenciados, uno de ellos tratado mediante tumorectomía simple; un paciente con degeneración liposarcomatoide de un lipoma atípico previo resecado; y otro paciente intervenido de un fibrohistiocitoma maligno retroperitoneal con posterior recidiva local a nivel de la región paratesticular.CONCLUSIONES: Los sarcomas de cordón espermático son una entidad poco frecuente que habitualmente se manifiestan como una masa paratesticular indolente. Su diagnóstico se efectúa mediante métodos de imagen (ecografía, TAC, RNM) y se confirma mediante el estudio histológico. El tratamiento es quirúrgico, existiendo cierta controversia acerca de la eficacia de tratamientos adyuvantes como la quimioterapia o la radioterapia(AU)

OBJECTIVE: To study and review spermatic cord sarcomas, including symptoms, diagnosis, and treat-ment.METHODS/RESULTS: We review the Spanish and international literature and report 4 new cases: 2 patients with well-differentiated spermatic cord liposarcomas (1 treated by simple tumorectomy), 1 patient with liposarcomatous dege-neration of a previously excised atypical lipoma, and 1 pa-tient operated for a malignant retroperitoneal fibrous histio-cytoma with subsequent local recurrence in the paratesticular region.CONCLUSIONS: Spermatic cord sarcomas are rare entities that usually appear as painless paratesticular mass. They are diagnosed by imaging studies (ultrasound, computed tomography, magnetic resonance) and confirmed by histological examination. Spermatic cord sarcomas are treated surgically; the efficacy of adjuvant treatments such as chemotherapy or radiation therapy is still under debate(AU)

Tumor testicular bilateral sincrónico de distancia histología / Bilateral synchronic testicular tumor of different histology

Objetivo: Presentar el caso de un tumor testicular germinal bilateral sincrónico de distinta histología. Método/ Resultado: Se trata de un paciente de 37 años que durante un estudio ecográfico, por sospecha de tumor testicular izquierdo, se apreció una tumoración testicular contralateral sincrónica. Se practicó orquiectomía inguinal bilateral y en el posterior estudio anatomopatológico se confirmó la presencia de la tumoración testicular bilateral de distinto componente histológico. Conclusión: Alrededor del 75% de los casos de tumoración testicular bilateral son metacrónicos, presentándose únicamente el 10% con diferente histología. El tipo histológico suele correlacionarse con el aspecto ecográfico, y el tratamiento de elección de un paciente con patología oncológica de este tipo es la orquiectomía inguinal bilateral (AU)

Objective: To report one case of bilateral synchronic germ cell testicular tumour of different histology. Methods/Results: 37-year-old patient with left testicular tumor under study was found to have a contralateral synchronic testicular tumor on ultrasound. Bilateral inguinal orchiectomy was performed and pathology reported the presence of bilateral testicular tumours of different histological type. Conclusions: Around 75% of the cases of bilateral testicular tumours are metachronic, with only 10% presenting different histology. Histological type often correlates with the ultrasound findings, and the treatment of choice in patients with this type of oncological pathology is bilateral inguinal orchiectomy (AU)

Supervivencia en relación a los factores pronósticos en una serie de pacientes con carcinoma de células renales / Prognostic-factor-related survival in a series of patients with renal cell carcinoma

OBJETIVO: Analizar la supervivencia de una serie de pacientes diagnosticados de carcinoma de células renales durante un periodo de 19 años en base a los factores pronósticos utilizados habitualmente en la práctica clínica. MÉTODOS: Estudio retrospectivo sobre 259 pacientes diagnosticados de manera consecutiva durante los años 1988 a 2006 carcinoma de células renales, que fueron tratados quirúrgicamente en nuestro servicio. A partir de los datos clínicos y patológicos y de seguimiento se ha hecho un estudio de supervivencia comparando el impacto de los factores pronósticos habituales: estadio, tamaño tumoral, grado nuclear, etc. RESULTADOS: Se realizaron 264 cirugías a los 259 pacientes de la muestra que presentaron una edad media de 61,91 años. El diagnóstico se realizó más frecuentemente por hallazgo incidental (52,12% de los casos), practicándose un 72,97% de nefrectomías radicales frente a un 26,25% de parciales. El carcinoma de células claras fue el diagnóstico histológico más frecuente (69,88%). Presentaron peor supervivencia los pacientes con carcinoma de células claras, los tumores sintomáticos, con mayor tamaño y grado nuclear de Fuhrman. A mayor estadio tumoral el pronóstico fue peor, especialmente en los tumores con estadio superior a pT3a. La presencia de ganglios linfáticos afectados o metástasis a distancia presentan una supervivencia cáncer-específica mucho más baja. La de supervivencia cáncer-específica global a los 5 años fue superior al 80%. CONCLUSIÓN: Los factores pronósticos usados clásicamente para predecir la supervivencia del cáncer renal siguen siendo útiles, en especial el estadio patológico pT. Se observa una mejor supervivencia en comparación con series más antiguas, pero este tipo de tumores sigue generando una morbimortalidad importante (AU)

OBJECTIVES: To analyze the survival rate in a series of patients with the diagnosis of renal cell carcinoma over a 19 year period based on prognostic factors usually employed in clinical practice. METHODS: Retrospective study of 259 consecutive patients with the diagnosis of renal cell carcinoma undergoing surgery in our department between 1988 and 2006. From clinical, pathological, and follow-up data we performed a survival study comparing the impact of usual prognostic factors: stage, tumor size, nuclear grade, etc. RESULTS: 264 surgical procedures were performed in 259 patients, with a mean age of 61.91 yr. The most frequent way of diagnosis was incidental finding (52.12% of the cases); radical nephrectomy was performed in 72.97% of the cases in comparison with 26.25% partial nephrectomies. Clear cell carcinoma was the most frequent histological diagnosis (69.88%). Patients with clear cell carcinoma, symptomatic tumors, bigger size, and greater Fuhrman nuclear grade presented worse survivals, mainly in tumors with stage >pT3a. The presence of involved lymph nodes or distant metas- tases is associated with a much lower cancer-specific survival. Global five-year cancer-specific survival was over 80%. CONCLUSIONS: The classical prognostic factors used to predict survival in renal cancer are still useful, mainly pathological stage pT. We observed a better survival in comparison with older series, but this kind of tumors continue generating important morbidity-mortality (AU)