Modelos predictivos de recidiva bioquímica en el cáncer de próstata tras tratamiento local. Validez de los nomogramas / Predictive models for biochemical recurrence of prostate cancer after local treatment. Nomograms

En la presente revisión narrativa presentamos una actualización del concepto de nomograma en el contexto de los modelos predictivos en cáncer de próstata. En realidad pretendemos dar respuesta desde un punto de vista práctico y a la vez crítico a las siguientes preguntas: ¿Qué es un nomograma?, ¿Cómo se leen y evalúan los nomogramas?, ¿Qué nomogramas predicen la recidiva bioquímica en cáncer de próstata tras tratamiento local, cirugía o radioterapia?, ¿Por qué son mejores los nomogramas que la estratificación en grupos de riesgo? y finalmente, ¿Por qué, en realidad, no se usan los nomogramas?(AU)

In this narrative review we present the concept of nomogram in the context of predictive mo-dels in prostate cancer. In fact we try to answer the following questions from a practical and critical point of view: What is a nomogram? How to read and evaluate nomograms? What nomograms predict biochemical relapse in prostate cancer after lo-cal treatment, either surgery or radiotherapy? Why are nomograms better than risk groups stratification? And, finally, Why don`t clinicians use nomograms in fact?(AU)

Un nuevo caso de histiocitoma fibroso maligno dependiente de cápsula renal / A new case of malignant fibrous histiocytoma arising from the renal capsule

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Expresion del receptor de esteroides y xenobioticos (SXR) y del gen de multirresistencia drogas (MDR1) y de los polimorfismos de las enzimas GSTs, SULTs y CYP en tumores vesicales profundos, analisis de su expresion y correlación con otros factores pronósticos / Steroid and xenobiotic receptor (SXR), multidrug resistance gene (MDR1) and GSTs, SULTs and CYP polymorphism expression in invasive bladder cancer, analysis of their expression and correlation with other prognostic factors

Introducción: El receptor de esteroides y xenobióticos SXR se ha demostrado su activación por parte de numerosos medicamentos, incluidos potentes inductores del citocromo P450, como la rifampicina y el cotrimazol. La función del SXR es bien conocida, y consiste en regular de manera positiva la trascripción del citocromo P450 3A4 (CYP3A4) y el gen de multirresistencia a drogas (multidrug resistance gene) MDR1, se considera una llave clave en el mecanismo regulador del metabolismo de los xenobióticos encontrándose involucrado en todas las fases de detoxificación Múltiples enzimas involucradas en el metabolismo y la degradación de hidrocarburos policíclicos aromáticos (PAH) son polimórficas en humanos, incluyendo la glutation S-transferasa (GSTs), N-acetiltransferasa (NATs), sulfotransferas (SULTs)1A1 y el citocromo p450 (CYP)1B1. Objetivos: Los objetivos que nos hemos planteado son los siguientes: 1. Analizar la expresión del factor de trascripción SXR y del MDR1 en vejiga mediante RT-PCR en tiempo real, tanto en vejiga tumoral como vejiga normal. 2. Analizar la relación de los factores clínicos y patológicos con la expresión del SXR y del MDR1. 3. Analizar la expresión de los polimorfismos de CYP1B1, GSTM1 GSTT1 y SULT1A1, y su correlación con distintos factores clínico patológicos y moleculares. Material y Métodos: De manera prospectiva se calculó un tamaño muestral necesario para este estudio. Se incluyeron 67 pacientes de dos instituciones distintas (Hospital Universitario Miguel Servet (49 HUMS) y Clínica Universitaria de Navarra (18 CUN)), diagnosticados de cáncer vesical infiltrante y tratados mediante cistectomía radical, se le realizó la determinación de la expresión de SXR y MDR1 mediante PCR cuantitativa en tiempo real, así como de los polimorfismos CYP1B1, GSTM1 GSTT1 y SULT1A1 mediante RFLP (restricción de la longitud del fragmento del polimorfismo). Se correlaciona mediante tablas de contingencia la correlación con el resto de los factores pronósticos. Resultados: La media de seguimiento de los pacientes fue de 23,7 meses, con una mediana de 28,26 meses. De los 67 pacientes estudiados, 31 pacientes (46,3%) presentaron progresión de la enfermedad, bien en forma de recidiva local, metástasis a distancia o ambos, con un tiempo medio a recidiva de 12,4 meses, mediana de 10 meses, con un rango de 1,1 mes a 31,9 meses. 36 pacientes (53,7%) no presentaron evidencia de progresión de la enfermedad. El receptor de esteroides y xenobióticos SXR así como el gen de multirresistenia a drogas (Multidrug resistance gene (MDR1)), se expresan en vejiga normal (0,94ΔCt y 0,94ΔCt) y en vejiga tumoral de la pieza de cistectomía (1,09 ΔCt y 0,45 ΔCt). Hemos analizado su expresión de manera cuantitativa y de manera cualitativa. La expresión de SXR se correlaciona con la presencia de carcinoma in situ (p=0,024), infiltración vasculo-linfática (p=0,05) mientras que MDR1 se correlaciona con la presencia de infiltración vasculo linfática (p=0,05) A su vez ambos la presencia de ambos factores se correlaciona entre ellos (p=0,011) Los polimorfismos: CYP1B1, GSTM1, GSTT1 y SULT1A1, se expresan en vejiga pero su expresión no guarda correlación con ningún factor pronóstico Conclusiones: El SXR y el MDR1 se expresan tanto en vejiga normal y tumoral. Y que dicha expresión guarda una correlación con factores pronósticos con influencia en la supervivencia descritas en la literatura

Introduction: Steroid and Xenobiotic Receptor (SXR) has demonstrated its activation by numerous drugs, including cytochrome P450 potent inducers like rifampicina or cotrimazol. The role of SXR is well known, and lies regulating in a positive manner cytochrome P450 3A4 (CYP3A4) transcription and the multidrug resistance gene (MDR1), it’s considered a key in the xenobiotic detoxification mechanism, being involved in all phases of the detoxification process. Enzymes involved in Policyclic Aromatic hidrocarbures (PAH) metabolism and degradation are polymorphic in humans, including glutation S-transferases (GSTs), N-acetiltransferases (NATs), sulfotransferases (SULTs)1A1 and cytochrome p450 (CYP)1B1. Objectives: The objectives we’ve planned are: 1. Analyze the expression of the transcription factor SXR and MDR1 in bladder by means of RT-PCR real time, both in normal bladder and in tumoral bladder. 2. Analyze the relation between clinical and pathological factors with the expression of SXR and MDR1. 3. Analyze the expression of the polymorphims CYP1B1, GSTM1 GSTT1 and SULT1A1 and their correlation with different clinic-pathological and molecular factors. Material and Methods: In a prospective way the size of the sample was estimated. In 67 patients from two institutions (Hospital Universitario Miguel Servet (49 HUMS) and Clinica Universitaria de Navarra (18 CUN)), diagnosed of invasive bladder cancer and treated by means of radical cystectomy, were determined the expression of both SXR and MDR1 by means of real time PCR, as well as the polymorphisms CYP1B1, GSTM1 GSTT1 y SULT1A1 by means of RFLP (Restriction fragment length polymorphism). Correlations with other prognostic factors by contingency tables were performed. Results: Average follow up was 23,7 months with a median of 28,26 months. Of the 67 patients studied, 31 patients (46,3) presented disease progression, in form of local recurrence or in distant metastasis or both. With a average time to progression of 12,4 months and a median of 10 months, with a range of 1,1 month to 31,9 month. 36 patients (53,7%) did not have any evidence of disease progression during follow up. The Steroid and Xenobiotic Receptor as well as the Multidrug Resistance Gene (MDR1) are expressed in both normal bladder (0,94ΔCt y 0,94ΔCt) and tumoral bladder in the cystectomy specimen(1,09 ΔCt y 0,45 ΔCt). We’ve analyzed their expression in a quantitative manner and in a qualitative manner. The expression of SXR correlates with the presence of ca. in situ (p=0,024), vasculo-lymphatic invasion (p=0,05) mean while MDR1 correlates with presence of vasculo-lymphatic invasion (p=0,05) Both factors are correlate between each others (p=0,011). Polymorphisms: CYP1B1, GSTM1, GSTT1 and SULT1A1, are expressed in these patients but their expression doesn’t correlates with any prognostic factor Conclusions: Both SXR and MDR1 are expressed in normal bladder as well as in tumoral bladder. And their expression correlates with different prognostic factors with influence in the survival described in the literature

[Are there any differences between the characteristics and the behavior of bladder cancer according to the age of presentation? Our experience]. / Existen diferencias en las caracteristicas y en el comportamiento del tumor vesical según edad de presentación? Nuestra experiencia.

INTRODUCTION: Owing to the different results from the series that evaluate the behavior of the bladder cancer according to the age at the moment of the diagnosis, our objective is based on valuing the characteristics and behaviour according to age of appearance. METHODS: A retrospective study of bladder cancer diagnosed in our area during decade 1993-2003, distributed in 3 intervals of age and some characteristics and behaviour are valued. RESULTS: Elderly patients present greater tumors, non differentiated and with greater rate of progression to infiltrated. Moreover the age, the pathological stage and the tumorlike degree appear as independent significant factors in the multivariant study. CONCLUSIONS: In our experience, the patients greater than 70 years present neoplasms of similar clinical characteristics, although pathologically more aggressive, with greater percentage of progression and worse survival.

¿Existen diferencias en las características y en el comportamiento del tumor vesical según edad de presentación? Nuestra experiencia / Are there any differences between the characteristics and the bahavior of bladder cancer according to the age of presentation? our experience

Objetivo: Dados los diferentes resultados de las series que evalúan el comportamiento de los tumores vesicales según la edad en la que debutan, nuestro objetivo se basa en valorar las características y comportamiento según edad de aparición. Método: Se realiza un estudio retrospectivo de los tumores vesicales de nuevo diagnóstico de nuestra área durante el decenio 1993-2003, distribuidos en 3 intervalos etarios y se evalúan diferentes características y comportamiento. Resultados: Se demuestra que los pacientes de más edad presentan tumores más grandes, indiferenciados y con mayor tasa de progresión hacia infiltrantes. Además aparecen como factores significativos independientes en el estudio multivariante: la edad, el estadio patológico y el grado tumoral. Conclusiones: En nuestra experiencia, los pacientes de edad mayor de 70 años presentan neoplasias de características clínicas similares, aunque patológicamente más agresivas, con mayor porcentaje de progresión y peor supervivencia

Introduction: Owing to the different results from the series that evaluate the behavior of the bladder cancer according to the age at the moment of the diagnosis, our objective is based on valuing the characteristics and behaviour according to age of appearance. Methods: A retrospective study of bladder cancer diagnosed in our area during decade 1993-2003, distributed in 3 intervals of age and some characteristics and behaviour are valued. Results: Elderly patients present greater tumors, non differentiated and with greater rate of progression to infiltrated. Moreover the age, the pathological stage and the tumorlike degree appear as independent significant factors in the multivariant study. Conclusions: In our experience, the patients greater than 70 years present neoplasms of similar clinical characteristics, although pathologically more aggressive, with greater percentage of progression and worse survival

[Usefulness of renal resistive index in the diagnosis and evolution of the obstructive uropathy. Experimental study]. / Utilidad del indice de resistencia renal en la valoración y evolución de la uropatía obstructiva. Estudio experimental.

OBJECTIVE: The study was focused on determining the effectiveness and reliability of using the renal resistance index as a method of diagnosing and monitoring the evolution of obstructive uropathy treatment. For this purpose, we conducted an experimental study on a homogenous group of animals that all had the same level of obstruction. MATERIAL AND METHODS: 15 healthy female pigs were used. The experiment was divided into three phases: phase I consisted of a study prior to unilateral pyeloureteral junction obstruction, performing retrograde ureteropyelography, renal B-mode ultrasound and duplex-Doppler (of both kidneys) at a level of the arcuate arteries. Then, the obstruction was performed on the animals. Phase II commenced by diagnosing the lesion, 6 weeks after the previous phase, by means of the aforementioned diagnostic methods. Finally, the endourological treatment was completed. Animals were monitored (Phase III) 15 weeks after the endopyelotomy, using the same methods as in the study, by assessing the urinary tract (fluoroscopy) and both kidneys by determining the renal resistance index and ratio. RESULTS: All the animals in the study showed signs of urinary obstruction on radiology and renal ultrasound 6 weeks after ureteral ligature. After treatment and follow-up, all animals showed signs of having recovered from the obstructive uropathy. Values of deltaRI during the 3 phases are detailed below. Fase I deltaIR = 0.01, Fase II deltaIR = 0.11, Fase III deltaIR = 0.02. CONCLUSION: RI determination using duplex-Doppler is effective for distinguishing obstructive dilatation using non-invasive techniques. However, this parameter provides very slight differences and it can also be influenced by too many direct and indirect factors (observational, patient age, anaesthesia, haemodynamic parameters, etc.), to supplant the classic diagnostic methods.

Utilidad del índice de resistencia renal en la valoración y evolución de la uropatía obstructiva. Estudio experimental / Usefulness of renal resistive index in the diagnosis and evolution of the obstructive uropathy. Experimental study

Objetivo: El planteamiento del estudio va enfocado a determinar la efectividad y fiabilidad de la medición del índice de resistencia renal (IR) para el diagnóstico y evolución tras el tratamiento de la uropatía obstructiva. Para ello realizamos un estudio experimental con un grupo homogéneo y con un grado de obstrucción uniforme. Material y métodos: Se emplean 15 animales de la especie porcina, todas hembras sanas. El planteamiento experimental está vertebrado en tres fases; la primera consiste en el estudio previo a la obstrucción de la unión pieloureteral unilateral mediante ureteropielografía retrógrada, nefrosonografía en modo B y dúplex-Doppler (ambos riñones) al nivel de las arterias arciformes. Posteriormente se procede a la creación del modelo animal de obstrucción. La Fase II comienza con el diagnóstico de la lesión 6 semanas después de la anterior fase, mediante los medios diagnósticos citados. Finalmente se completa el tratamiento endourológico. El seguimiento de los animales (Fase III) se realiza transcurridas 15 semanas tras la endopielotomía, valorando al igual que durante el estudio, la vía urinaria (fluoroscopia) y la afectación en ambos riñones mediante la determinación del índice de resistencia renal y su ratio. Resultados: Todos los animales del estudio mostraron signos radiológicos y nefrosonográficos de obstrucción urinaria tras 6 semanas de la ligadura ureteral. Tras el tratamiento y seguimiento todos los animales mostraron signos de recuperación de la uropatía obstructiva. Los valores del DeltaIR a lo largo de las 3 fases se detallan a continuación. Fase I DeltaIR = 0.01, Fase II DeltaIR = 0.11, Fase III DeltaIR = 0.02. Conclusiones: La valoración del IR mediante dúplex-Doppler es efectiva para la diferenciación de la dilatación obstructiva mediante técnicas no invasivas. Pero este parámetro aporta unas diferencias muy leves y además puede verse afectado por demasiados factores de modo directo o indirecto (observador, edad del paciente, anestesia, parámetros hemodinámicos, etc.), como para relegar los métodos de diagnóstico clásicos

Objective: The study was focused on determining the effectiveness and reliability of using the renal resistance index as a method of diagnosing and monitoring the evolution of obstructive uropathy treatment. For this purpose, we conducted an experimental study on a homogenous group of animals that all had the same level of obstruction. Material and methods: 15 healthy female pigs were used. The experiment was divided into three phases: phase I consisted of a study prior to unilateral pyeloureteral junction obstruction, performing retrograde ureteropyelography, renal Bmode ultrasound and duplex-Doppler (of both kidneys) at a level of the arcuate arteries. Then, the obstruction was performed on the animals. Phase II commenced by diagnosing the lesion, 6 weeks after the previous phase, by means of the aforementioned diagnostic methods. Finally, the endourological treatment was completed. Animals were monitored (Phase III) 15 weeks after the endopyelotomy, using the same methods as in the study, by assessing the urinary tract (fluoroscopy) and both kidneys by determining the renal resistance index and ratio. Results: All the animals in the study showed signs of urinary obstruction on radiology and renal ultrasound 6 weeks after ureteral ligature. After treatment and follow-up, all animals showed signs of having recovered from the obstructive uropathy. Values of DeltaRI during the 3 phases are detailed below. Fase I DeltaIR = 0.01, Fase II DeltaIR = 0.11, Fase III DeltaIR = 0.02. Conclusion: RI determination using duplex-Doppler is effective for distinguishing obstructive dilatation using non-invasive techniques. However, this parameter provides very slight differences and it can also be influenced by too many direct and indirect factors (observational, patient age, anaesthesia, haemodynamic parameters, etc.), to supplant the classic diagnostic methods

[Steroid and xenobiotic receptor (SXR), multidrug resistance gene (MDR1) and GSTs, SULTs and CYP polymorphism expression in invasive bladder cancer, analysis of their expression and correlation with other prognostic factors]. / Expresion del receptor de esteroides y xenobioticos (SXR) y del gen de multirresistencia drogas (MDR1) y de los polimorfismos de las enzimas Gsts, SULTs y CYP en tumores vesicales profundos, analisis de su expresion y correlación con otros factores pronósticos.

INTRODUCTION: Steroid and Xenobiotic Receptor (SXR) has demonstrated its activation by numerous drugs, including cytochrome P450 potent inducers like rifampicina or cotrimazol. The role of SXR is well known, and lies regulating in a positive manner cytochrome P450 3A4 (CYP3A4) transcription and the multidrug resistance gene (MDR1), it's considered a key in the xenobiotic detoxification mechanism, being involved in all phases of the detoxification process. Enzymes involved in Policyclic Aromatic hidrocarbures (PAH) metabolism and degradation are polymorphic in humans, including glutation S-transferases (GSTs), N-acetiltransferases (NATs), sulfotransferases (SULTs)1A1 and cytochrome p450 (CYP)1B1. OBJECTIVES: The objectives we've planned are: 1. Analyze the expression of the transcription factor SXR and MDR1 in bladder by means of RT-PCR real time, both in normal bladder and in tumoral bladder. 2. Analyze the relation between clinical and pathological factors with the expression of SXR and MDR1. 3. Analyze the expression of the polymorphims CYP1B1, GSTM1 GSTT1 and SULT1A1 and their correlation with different clinic-pathological and molecular factors. MATERIAL AND METHODS: In a prospective way the size of the sample was estimated. In 67 patients from two institutions (Hospital Universitario Miguel Servet (49 HUMS) and Clinica Universitaria de Navarra (18 CUN)), diagnosed of invasive bladder cancer and treated by means of radical cystectomy, were determined the expression of both SXR and MDR1 by means of real time PCR, as well as the polymorphisms CYP1B1, GSTM1 GSTT1 y SULT1A1 by means of RFLP (Restriction fragment length polymorphism). Correlations with other prognostic factors by contingency tables were performed. RESULTS: Average follow up was 23.7 months with a median of 28.26 months. Of the 67 patients studied, 31 patients (46.3) presented disease progression, in form of local recurrence or in distant metastasis or both. With a average time to progression of 12.4 months and a median of 10 months, with a range of 1.1 month to 31.9 month. 36 patients (53.7%) did not have any evidence of disease progression during follow up. The Steroid and Xenobiotic Receptor as well as the Multidrug Resistance Gene (MDR1) are expressed in both normal bladder (0.94DeltaCt y 0.94DeltaCt) and tumoral bladder in the cystectomy specimen (1.09 DeltaCt y 0.45 DeltaCt). We've analyzed their expression in a quantitative manner and in a qualitative manner. The expression of SXR correlates with the presence of ca. in situ (p=0.024), vasculo-lymphatic invasion (p=0.05) mean while MDR1 correlates with presence of vasculo-lymphatic invasion (p=0.05) Both factors are correlate between each others (p=0.011). Polymorphisms: CYP1B1, GSTM1, GSTT1 and SULT1A1, are expressed in these patients but their expression doesn't correlates with any prognostic factor CONCLUSIONS: Both SXR and MDR1 are expressed in normal bladder as well as in tumoral bladder. And their expression correlates with different prognostic factors with influence in the survival described in the literature.

[Incidental prostatic cancer: T1a-T1b. Our experience after observation/radical surgery and literature review]. / Cáncer de próstata incidental: T1a-T1b. Nuestra experiencia tras observación/intervención radical y revisión de la literatura.

OBJECTIVES: To analyse the progress of T1a and T1b prostate cancer diagnosed in our hospital. MATERIAL AND METHODS: Retrospective study of 40 patients in T1a-T1b clinical stage diagnosed with prostate adenocarcinoma in our hospital, from 1986 to 1999. A restaging biopsy was performed on the 16 T1a patients after initial diagnosis and control. A radical prostatectomy was performed on the 24 T1b patients. They were all monitored every six months with rectal exam and PSA. We analysed biological and/or clinical progression, time to progression, mortality caused by the tumour and survival. RESULTS: None of the 16 patients with T1a clinical stage presented tumour progression, with a median follow-up of 90 months. 12,5% of the 24 T1b cases presented tumour progression, with a median follow-up of 70 months. Cancer-specific mortality was one patient (4,16 %) in the T1b group. CONCLUSIONS: Observation and follow-up with PSA and rectal exam appears to be a good option for T1a clinical stage, given the good prognosis. Our results show that patients with T1a clinical stage and good prognostic factors could be at a similar risk of suffering from a new prostate cancer as the normal population, although prospective studies are required to validate these results. T1b cases require active treatment and closer monitoring.

[Stage pT0 bladder tumors after radical cystectomy: a review of our series]. / Tumores de vejiga pT0 tras cistectomía radical: análisis de nuestra serie.

OBJECTIVES: To evaluate the data of progression and survival in 43 patients who underwent cystectomy with stage pT0 according to classification TNM-2002. MATERIALS AND METHODS: between 1988 and 2003 in our center had realized 420 cystectomies, 43 patients (10.2%) had not tumor in the cystectomy specimen. RESULTS: In these 43 cases the initial clinical stage (in the transuretral resection of bladder) was T1 in 10 cases (23,3 %), T2 in 31 cases (72%) and T3 in 2 cases. As far as the degree 24 patients presented G2 (55.8%) and 19 (44.2%) were G3. Median time from the transuretral resection to the cistectomy was of 44 days at a median follow-up of 89.3 months. Progression-free survival in the 43 patients was of 180,6 months, but during the follow-up it appeared progression in 7 patients, with disease free survival at 36 months (3-126), since the date of the cistectomia. During the follow up, 5 patients died. When we analyzed the cancer-specific survival according to tumor stage, for the T2 with an average cancer-specific survival is of 180 months, decreasing to 35 months considerably for T3. Similar it happens with the degree of differentiation, significantly diminishing as it advances the degree, with an average of cancer-specific survival for the G3 at 122.6 months. In the same way it happens with pathological positive lymph nodes in the radical cistectomy, with a cancer-specific survival of 188 months when it is N0 and of 54 months if the adenopathy was positive (N+). CONCLUSION: In our experiencie urothelial carcinoma pT0 present a prolonged free period of disease (medium of 180 months). The associated factors of risk to a smaller free period of disease are high degree of differentiation (G3, 116 months), the infiltration of deep layers in the transuretral resection (T3, 32 months) and the ganglionary affectation (pN+ 45 months).

[Papillary carcinoma after 13 years of correct function of renal graft]. / Carcinoma papilar hallado en injerto renal tras 13 años de correcto funcionamiento.

It is known the greater probability appearance of malignancy injuries in patients with renal graft due to its inmunosupresión. We expose a case in which after thirteen years of correct operation of the renal transplant a tumor is diagnosed of accidental form by means of ultrasonography of graft's control. It was demonstrated by percutaneous biopsy that it was a carcinoma to papilar and later transplanctectomy was made. We raised a reflection about the novo tumors on renal graft given to the high number of patients with funcionante transplant during long years and the little evidence in Literature, proposing a possible registry of such valuing its behavior and comparing it with the well-known ones on native kidneys without inmunosupresión situation.

[The present time in handling of prostate abscesses: with regard to a case]. / Actualidad en manejo de abcesos prostáticos: a propósito de un caso.

The existence of prostate abscess as bad evolution of an acute protatitis is not very frequent due to the correct handling of the urinary infections by means of suitable antibiotics, in spite of the presence of inmunosupresion situations that can favor their appearance. It is our intention to review the performance in these situations because of a case that by means of minimal invasive therapy by transperineal percutaneous puncture obtained complete improvement.

Tumores de vejiga pT0 tras cistectomía radical: análisis de nuestra serie / Stage pT= cystectomy: a review of our serie

Objetivos: Estudiar los datos de progresión y supervivencia en los 43 pacientes cistectomizados y catalogados de pT0 según la clasificación TNM-2002. Material y Métodos: Entre 1988 y 2003 se han realizado en nuestro centro 420 cistectomías, en 43 casos(10,2%) no se halló tumor en la pieza anatomopatológica siendo éstos el núcleo de nuestro análisis. Resultados: En estos 43 casos el estadio clínico inicial (en la resección transuretral de tumor vesical previa a la cistectomía) fue T1 en 10 casos (23,3%), T2 en 31 casos (72%) y T3 en 2 casos. En cuanto al grado 24 pacientes presentaron G2 (55,8%) y 19 (44,2%) fueron G3. La mediana entre la de resección transuretral de tumor vesical diagnóstica (RTU de TM vesical) y la cistectomía fue de 44 días y la mediana del seguimiento fue de 89,3 meses. Progresión. La supervivencia libre de progresión en los 43 pacientes fue de 180,6 meses, pero durante el seguimiento apareció progresión en 7 pacientes con una mediana de supervivencia libre de progresión desde la fecha de la cistectomía de 36 meses (3-126). Supervivencia cáncer-específica (SCE). Durante el seguimiento, 5 enfermos fallecieron, cuatro por la enfermedad y el quinto por un cáncer de pulmón. Si analizamos la SCE, según la anatomía patológica de la RTU de tumor vesical previa, para los T2 la media de SCE es de 180 meses, disminuyendo considerablemente para T3 hasta 35 meses. Similar ocurre con el grado de diferenciación tumoral, disminuyendo significativamente a medida que avanza el grado, con una media de SCE para los G3 de122,6 meses. Del mismo modo ocurre con la afectación ganglionar en la pieza de la cistoprostatectomía radical, con una SCE de 188 meses cuando es N0 y de 54 meses si los ganglios son positivos (N+). Conclusiones: En nuestra experiencia los tumores uroteliales pT0 presentan un periodo libre de enfermedad prolongada (mediana de 180 meses). Los factores de riesgo asociados a un menor periodo libre de enfermedad (PLE) son alto grado de diferenciación (G3, 116 meses), la infiltración de capas profundas en la RTU de tumor vesical(T3, 32 meses) y la afectación ganglionar (pN+) 45 meses

Objectives: To evaluate the data of progression and survival in 43 patients who underwent cystectomy with stage pT0 according to classification TNM-2002. Matherials and methods: between 1988 and 2003 in our center had realized 420 cystectomies, 43 patients (10.2%) had not tumor in the cystectomy specimen. Results: In these 43 cases the initial clinical stage (in the transuretral resection of bladder) was T1 in 10 cases (23,3 %), T2 in 31 cases (72%) and T3 in 2 cases. As far as the degree 24 patients presented G2 (55.8%) and 19 (44.2%) were G3. Median time from the transuretral resection to the cistectomy was of 44 days at a median follow-up of 89.3 months. Progressionfree survival in the 43 patients was of 180,6 months, but during the follow-up it appeared progression in 7 patients, with disease free survival at 36 months (3-126) ,since the date of the cistectomía. During the follow up, 5 patients died. When we analyzed the cancer-specific survival according to tumor stage, for the T2 with an average cancer-specific survival is of 180 months, decreasing to 35 months considerably for T3. Similar it happens with the degree of differentiation, significantly diminishing as it advances the degree, with an average of cancer-specific survival for the G3 at 122.6 months. In the same way it happens with pathological positive lymph nodes in the radical cistectomy , with a cancer- specific survival of 188 months when it is N0 and of 54 months if the adenopathy was positive (N+). Conclusion: In our experiencie urothelial carcinoma pT0 present a prolonged free period of disease (medium of 180 months). The associated factors of risk to a smaller free period of disease are high degree of differentiation (G3, 116 months), the infiltration of deep layers in the transuretral resection(T3, 32 months) and the ganglionary affectation (pN+ 45 months)

Carcinoma papilar hallado en injerto renal tras 13 años de correcto funcionamiento / Carcinoma papilar after 13 years of correct function of graft renal

Es conocida la mayor probabilidad de aparición de lesiones malignas en pacientes con trasplante renal debido a su inmunosupresión. Exponemos un caso en el que tras trece años de correcto funcionamiento del trasplante renal se diagnostica de forma casual mediante ecografía de control un tumor sobre el injerto. Mediante punción ecodirigida se evidenció que se trataba de un carcinoma papilar y se realizó trasplantectomía posterior. Planteamos una reflexión acerca de los tumores de novo sobre injerto renal dado el alto número de pacientes con trasplante funcionante durante largos años y la escasa evidencia en la literatura, proponiendo un posible registro de los mismos para valorar su comportamiento y compararlo con los conocidos sobre riñones nativos sin situación de inmunosupresión

It is known the greater probability appearance of malignancy injuries in patients with renal graft due to its inmunosupresión. We expose a case in which after thirteen years of correct operation of the renal transplant a tumor is diagnosed of accidental form by means of ultrasonography of graft´s control. It was demonstrated by percutaneous biopsy that it was a carcinoma to papilar and later transplanctectomy was made. We raised a reflection about the novo tumors on renal graft given to the high number of patients with funcionante transplant during long years and the little evidence in Literature, proposing a possible registry of such valuing its behavior and comparing it with the well-known ones on native kidneys without inmunosupresión situation

Actualidad en manejo de abcesos prostáticos: a propósito de un caso / The present time in handling of prostate abscesses: with regard to case

La existencia de abscesos prostáticos como mala evolución de una prostatitis aguda no es muy frecuente dado al correcto manejo de las infecciones urinarias mediante antibioterapia adecuada, a pesar de ello existen situaciones de inmunosupresión que pueden favorecer su aparición. Es nuestro propósito revisar la actuación en estas situaciones a raíz de un caso que mediante un drenaje percutáneo mínimamente invasivo consiguió completa mejoría

The existence of prostate abscess as bad evolution of an acute protatitis is not very frequent due to the correct handling of the urinary infections by means of suitable antibiotics, in spite of the presence of inmunosupresion situations that can favor their appearance. It is our intention to review the performance in these situations because of a case that by means of minimal invasive therapy by transperineal percutaneous puncture obtained complete improvement

[Development of tissue microarray technology (TMA) for immunohistochemical study of molecular expression profiling in prostate cancer (part 1)]. / Desarrollo de un microarray tisular (TMA) para el estudio inmunohistoquímico del patrón de expresión molecular en el cáncer de próstata (parte 1).

Tissue microarray technology (TMA) is nowadays considered as a powerful tool for the high-throughput analysis of molecular expression pattern of cancer. In this manuscript we show the experience of both groups in the design and building of a TMA for the study of protein expression pattern of prostatecancer as well as a summary of the technical points to analyze the results obtained with this technology. Today, different data generated by the immunostained tissues are studied to achieve a molecular profile in different clinical scenarios.

Controversies related to epithelioid variant of renal angiomyolipoma: a review of the literature.

We performed a review of the epithelioid-type angiomas to determine their clinical course and propose an appropriate plan for follow-up. We present the case of a patient with possible adrenal carcinoma suggested by computed tomography for whom the histopathologic study revealed an epithelioid angiomyolipoma arising from the kidney. In the absence of consensus, we consider it worthwhile to register the very few cases diagnosed and record a detailed follow-up of the clinical course. We recommend surgical treatment and a follow-up regimen similar to that for renal carcinoma.

Desarrollo de un microarray tisular (TMA) para el estudio inmunohistoquímico del patrón de expresión molecular en el cáncer de próstata (Parte 1) / Development of tissue microarray technology (TMA) for immunohistochemical study of molecular expression profiling in prostate cancer (Part 1)

El microarray tisular (TMA) es considerado hoy en día una potente herramienta para el análisis masivo del perfil molecular del cáncer. En este trabajo describimos la experiencia de ambos centros en el diseño y creación de un TMA para el estudio de la expresión molecular del cáncer de próstata así como una revisión de los diferentes aspectos técnicos necesarios para el análisis de los resultados obtenidos con esta técnica. En la actualidad, se están estudiando los datos generados por las distintas técnicas inmunohistoquímicas para la obtención de un patrón molecular en diferentes estadios clínicos

Tissue microarray technology (TMA) is nowadays considered as a powerful tool for the high-throughput analysis of molecular expression pattern of cancer. In this manuscript we show the experience of both groups in the design and building of a TMA for the study of protein expression pattern of prostate cancer as well as a summary of the technical points to analyze the results obtained with this technology. Today, different data generated by the immunostained tissues are studied to achieve a molecular profile in different clinical scenarios