The management of active surveillance in prostate cancer: validation of the Canary Prostate Active Surveillance Study risk calculator with the Spanish Urological Association Registry.

The follow up of patients on active surveillance requires to repeat prostate biopsies. Predictive models that identify patients at low risk of progression or reclassification are essential to reduce the number of unnecessary biopsies. The aim of this study is to validate the Prostate Active Surveillance Study risk calculator (PASS-RC) in the multicentric Spanish Urological Association Registry of patients on active surveillance (AS), from common clinical practice. RESULTS: We find significant differences in age, PSA and clinical stage between our validation cohort and the PASS-RC generation cohort (p < .0001), with a reclassification rate of 10-22% on the follow-up Bx, no cancer was found in 43% of the first follow-up Bx. The calibration curve shows underestimation of real appearance of reclassification. The AUC is 0.65 (C.I.95%: 0.60-0.71). PDF and CUC do not suggest a specific cut-off point of clinical use. METHODS: We select 498 patients on AS with a minimum of one follow-up biopsy (Bx) from the 1,024 males registered by 36 Spanish centers recruiting patients on the Spanish Urological Association Registry on AS. PASS-RC external validation is carried by means of calibration curve and area under de ROC-curve (AUC), identifying cut-offs of clinical utility by probability density functions (PDF) and clinical utility curves (CUC). CONCLUSIONS: In our first external validation of the PASS-RC we have obtained a moderate discrimination ability, although we cannot recommend cut-off points of clinical use. We suggest the exploration of new biomarkers and/or morpho-functional parameters from multiparametric magnetic resonance image, to improve those necessary tools on AS.

[Primary testicular lymphoma. Report of two cases and bibliographic review]. / Linfoma testicular primario. Presentación de dos casos y revisión de la literatura.

OBJECTIVE: We report two cases of primary testicular lymphoma and performed a bibliography review about this pathology. METHODS/RESULTS: We describe two cases of primary testicular lymphoma in two male patients 69 and 61 yr. old respectively. In both cases, reason for consultation was increase of the right testicular size. After inguinal orchyectomy the diagnosis for the first case was large and medium T cell diffuse lymphoma, stage I (E)-A; three years after chemotherapy (R-CHOP) the patient is in complete remission. In the second case, the diagnosis was diffuse large B-cell lymphoma, and after receiving various chemotherapy regimens died 14 months after diagnosis. CONCLUSIONS: Testicular lymphoma is a very rare entity, despite being considered the most common testicular tumor in patients over the age of 60 years. Most of them are non-Hodgkin diffuse, intermediate or high grade of malignancy, B-cell immunophenotype, being T cell exceptional. Prognosis is poor due to their high tendency to systemic dissemination. The treatment is based on orchiectomy, chemotherapy and radiotherapy, although there is not a standardized regimen.

[Old schwannoma: a rare type of schwannoma]. / Schwannoma antiguo: variante rara de schwannoma.

OBJECTIVES: We report one case of retroperitoneal schwannoma with unfrequent histological characteristics evaluating its clinical significance and therapeutic options. METHODS: We report the case of a benign retroperitoneal schwannoma as an incidental MRI finding in a 70 year-old female patient with symptoms of lumbosciatic pain for 6 months. We perform a bibliographic review. RESULTS: After surgical excision the diagnosis was retroperitoneal old schwannoma. No additional treatment was given. There is no evidence of recurrence on follow-up. The histological changes apparent in the cases of old schwannoma have been interpreted as degenerative, indicating a long evolution, which has motivated its denomination as old. Some cases have been diagnosed as malignant. CONCLUSIONS: The old schwannoma is a rare variety of the benign common schwannoma. Microscopically its shows areas of hypocellular tissue and pleomorphic nuclei suggestive of malignancy. Therapeutic management is similar to other benign retroperitoneal processes, surgical excision and follow-up.

Schwannoma antiguo: variante rara de schwannoma / Old schwannomaa. a rare type of schwannoma

OBJETIVO: A propósito de un caso deschwannoma retroperitoneal con características histológicaspoco frecuentes, se evalúa su significación clínica eindicaciones de manejo terapeutico.MÉTODOS: Presentación de un caso de schwannomaretroperitoneal benigno, como hallazgo incidental, alpracticar una Resonancia Magnética, en una paciente de70 años cuya clínica era de una lumbociática de seismeses de evolución. Revisión bibliográfica.RESULTADOS: Tras la exéresis quirúrgica se llegó al diagnósticode schwannoma retroperitoneal antiguo. No seadministra ningún tratamiento complementario. No se haevidenciado recidiva durante seguimiento. Los cambioshistológicos que se ven en los casos de schawannomaantiguo se han interpretado como degenerativos, indicandouna larga evolución, que ha motivado su denominaciónde “antiguos”. Algunos de los casos fueron diagnosticadoscomo malignos.CONCLUSIONES: El schwannoma antiguo es una variantepoco habitual del schwannoma común benigno.Microscópicamente muestra áreas de tejido hipocelular ynúcleos pleomórficos sugestivos de malignidad. Su manejoterapéutico es similar al de otros procesos benginosretroperitoneales, mediante exéresis quirúrgica y seguimiento

OBJECTIVES: We report one case ofretroperitoneal schwannoma with unfrequent histologicalcharacteristics evaluating its clinical significance andtherapeutic options.METHODS: We report the case of a benign retroperitonealschwannoma as an incidental MRI finding in a 70-yearoldfemale patient with symptoms of lumbosciatic painfor 6 months. We perform a bibliographic review.RESULTS: After surgical excision the diagnosis wasretroperitoneal old schwannoma. No additionaltreatment was given. There is no evidence of recurrenceon follow-up. The histological changes apparent in thecases of old schwannoma have been interpreted asdegenerative, indicating a long evolution, which hasmotivated its denomination as old. Some cases havebeen diagnosed as malignant.CONCLUSIONS: The old schwannoma is a rarevariety of the benign common schwannoma.Microscopically its shows areas of hypocellular tissueand pleomorphic nuclei suggestive of malignancy.Therapeutic management is similar to other benignretroperitoneal processes, surgical excision and followup

[Sarcomatoid renal carcinoma. Report of 2 cases]. / Carcinoma renal sarcomatoide. Presentación de dos casos.

OBJECTIVE: To describe two cases of sarcomatoid renal carcinoma, one of them is alive after five years from surgery. METHODS: Both patients had undergone radical nephrectomy, without complementary treatment. RESULTS: One patient is alive after five years; the second patient presented acute renal failure and died after five days from surgery. CONCLUSIONS: Sarcomatoid renal carcinoma is a uncommon variety of renal cell carcinoma, with highly malignant behavior. The median survival is six months, but exceptional cases with larger survival (five years) have been reported in the literature.

Carcinoma renal sarcomatoide. Presentación de dos casos / Sarcomatoid renal carcinoma. Report of two cases

OBJETIVO: Presentar dos nuevos casos de carcinoma renal sarcomatoide, uno de los cuales tiene más de cinco años de supervivencia tras cirugía. MÉTODOS: Ambos pacientes fueron sometidos a nefrectomía radical, sin otro tipo de tratamiento coadyuvante. RESULTADOS: Uno de los pacientes presenta una supervivencia de más de cinco años; el segundo paciente falleció por fracaso renal agudo cinco días después de la intervención. CONCLUSIONES: Se trata de una neoplasia renal poco frecuente y altamente maligna. La supervivencia media es de seis meses, existiendo casos muy aislados en la literatura con supervivencias mayores de cinco años (AU)

Leiomioma vesical / Leiomyoma of the bladder

El leiomioma vesical es una neoformación benigna que supone menos del 0,43 por ciento de los tumores de vejiga. Se aporta un nuevo caso diagnosticado en un varón con síndrome prostático y litiasis vesical. Se realiza revisión de la literatura y se comentan los aspectos clínicos, diagnósticos y terapéuticos del mismo (AU)