Prostate cancer mortality rates in Peru and its geographical regions.

OBJECTIVE: To evaluate the mortality rates for prostate cancer according to geographical areas in Peru between 2005 and 2014. MATERIALS AND METHODS: Information was extracted from the Deceased Registry of the Peruvian Ministry of Health. We analysed age-standardised mortality rates (world population) per 100 000 men. Spatial autocorrelation was determined according to the Moran Index. In addition, we used Cluster Map to explore relations between regions. RESULTS: Mortality rates increased from 20.9 (2005-2009) to 24.1 (2010-2014) per 100 000 men, an increase of 15.2%. According to regions, during the period 2010-2014, the coast had the highest mortality rate (28.9 per 100 000), whilst the rainforest had the lowest (7.43 per 100 000). In addition, there was an increase in mortality in the coast and a decline in the rainforest over the period 2005-2014. The provinces with the highest mortality were Piura, Lambayeque, La Libertad, Callao, Lima, Ica, and Arequipa. Moreover, these provinces (except Arequipa) showed increasing trends during the years under study. The provinces with the lowest observed prostate cancer mortality rates were Loreto, Ucayali, and Madre de Dios. This study showed positive spatial autocorrelation (Moran's I: 0.30, P = 0.01). CONCLUSION: Mortality rates from prostate cancer in Peru continue to increase. These rates are higher in the coastal region compared to those in the highlands or rainforest.

Epithelioid angiomyolipoma: a rare variant of renal angiomyolipoma.

OBJECTIVE: We present a case of primary renal epithelioid angiomyolipoma, its association with tuberous sclerosis and review the literature. METHODS: We present the case of a 12 year-old male with past medical history of tuberous sclerosis, characterized by developmental delay, tonic and clonic seizures, and cutaneous abnormalities. He presented with macroscopic hematuria and abdominal pain. CT scan of the abdomen showed the presence of a left renal tumor. He underwent left radical nephrectomy. Pathologic study of the specimen showed primary renal epithelioid angiomyolipoma, corroborated by immunohistochemistry staining. Review of the literature was performed for this rare variant and its malignant potential. RESULTS: The presence of this epithelial variant is rare and must be taken into account because of its malignant potential and, thus, with different prognosis and follow up, compared to classical angiomyolipoma. CONCLUSIONS: Renal angiomyolipoma is an uncommon benign tumor, representing a challenge for clinical and pathological diagnosis. Despite the big size they can reach, as well as bilaterality, multiplicity of lesions and/or lymphatic regional involvement, its malignant potential has not been established. Nevertheless, the epithelioid variant has been described recently, a rare entity with aggressive behavior, difficult histological characterization and poor prognosis.

[Paratesticular sarcoma with synchronous renal carcinoma.] / Sarcoma indiferenciado pleomorfico paratesticular sincrónico con carcinoma renal.

OBJETIVE: Primary undifferentiated pleomorphic sarcoma (UPS) of the testicular tunics is rare, and synchronism with other malignancies of the urinary tract is uncommon, and may complicate the staging and therapeutic approach. We report the case of a patient diagnosed with primary paratesticular UPS with synchronous Renal Carcinoma. METHODS: Patient presenting with intrascrotal tumor who underwent left radical orchiectomy. In staging work up studies a second urologic neoplasia was found in the kidney. Histological diagnosis using immunohistochemical techniques for adequate characterization was performed. Adjuvant treatment options were evaluated. We review the literature and discuss the case. RESULTS: The UPS diagnosis was performed with immunohistochemistry. Paratesticular origin from testicular tunics was evident in the macroscopic evaluation. After finding the synchronic ipsilateral renal tumor, he underwent conventional left radical nephrectomy, ipsilateral adrenalectomy, excision of remnant left cord and para-aortic and pelvic lymphadenectomy. He received chemotherapy and adjuvant radiotherapy. Currently, after twelve months of follow-up there is no evidence of disease. CONCLUSIONS: The UPS is a heterogeneous group with an exclusion immunohistochemical diagnosis. Its management requires a multidisciplinary approach; the initial surgical treatment is accepted for the paratesticular mass with high section radical orchiectomy. Although there is insufficient evidence of the efficacy of adjunctive lymphadenectomy, chemotherapy and/or radiotherapy.

Leiomyosarcoma of the renal vein: case report and review of the literature.

Leiomyosarcomas of vascular origin is a rare and aggressive pathology, its presentation on the renal vein is infrequent, of which 29 cases have been reported world-wide. We describe a case of a 76 year-old woman, who presented with intermittent left flank pain, irradiated to the lumbar region of 6 months duration. A left radical nephrectomy with en-bloc resection of a para-aortic tumor was performed. Microscopic examination of the specimen reported a moderately differentiated leiomyosarcoma, originated in the wall of the renal vein. The patient received adjuvant chemotherapy and radiation therapy. The tumor recurred in the liver. After 24 months from the primary surgery, the patient is alive with evidence of multiple metastatic spread to the liver. She is now under palliative care.

Endoscopic inguinal lymphadenectomy in penile cancer: case report and literature review.

OBJECTIVES: The objective was to submit our first experience in endoscopic inguinal lymphadenectomy (EIL), evaluate the feasibility of the procedure and carry out a review of the literature. MATERIAL AND METHODS: A 41-year-old patient was diagnosed with penile cancer with squamous cell carcinoma pT2G1 pathology, with no palpable inguinal lymph nodes. A bilateral inguinal lymphadenectomy was performed with preservation of the saphenous vein, conventional left and endoscopic right procedures. The perioperative data is presented and that obtained is discussed in the literature. RESULTS: The total time was 270 minutes, 180 for endoscopic and 90 for conventional procedures. Blood loss was minimal in both cases. Fifteen lymph nodes were dissected on the endoscopic side, and 17 in the conventional side, the latter with more pain and devitalised skin flap. CONCLUSIONS: EIL for penile cancer is feasible and there is less morbidity with an early recovery. The literature is not conclusive on the indication of EIL.

[Challenges to early diagnosis of prostate cancer in Peru]. / Retos para el diagnóstico precoz del cáncer de próstata en el Perú.

Early detection of prostate cancer in Peru is very uncommon, as patients usually arrive when the disease is locally advanced or advanced. There are no prostate cancer screening campaigns that allow us to detect this disease in early stages. The incidence rates, according to the Registry of Cancer in Metropolitan Lima, are increasing. However, there is probably an under register of cases in our country, since there are not any nation-wide records showing the real magnitude of this disease. It is imperative to develop prevention programs for the early diagnosis of prostate cancer through digital rectal exams and to perform the measurement of the prostate- specific antigen (PSA) in the blood.

Epidemiology and natural history of penile cancer.

An extensive literature search was performed using the key words squamous cell carcinoma of the penis, phimosis, circumcision, chronic balanitis, cigarette smoking, genital warts and human papillomavirus (HPV) infection. All selected studies were classified according to the level of evidence (LE). The final grades of recommendation were assigned after discussion by the full panel of the International Consultation on Penile Cancer in November 2008. The factors positively associated with invasive penile cancers include the presence of phimosis (LE 3a), tobacco smoking (LE 3a-4), chewing tobacco (LE 3a), injury to the penis (LE 3a), balanitis (LE 3a), genital warts (LE 3a), and high-risk HPV infection (LE 3a-4).

Prostate cancer in Latin America.

There is a very low rate of early prostate cancer detection in Latin America, since patients usually are diagnosed when the disease is in advanced stages. Sporadic prostate cancer screening campaigns do exist which allow us to diagnose this disease in earlier stages. Incidence and mortality rates differ widely from country to country, and they are probable underreported in our region since registers may be city-based instead of country-based.

Retos para el diagnóstico precoz del cáncer de próstata en el Perú / Challenges to early diagnosis of prostate cancer in Peru

La detección temprana del cáncer de próstata en el Perú es muy baja, ya que los pacientes, por lo general, llegan con la enfermedad localmente avanzada o avanzada. No existen campañas de tamizaje del cáncer de próstata que nos permitan detectar esta enfermedad en estadios tempranos. Las tasas de incidencia, según el Registro de Cáncer de Lima Metropolitana, van en aumento, a pesar de existir probablemente un subregistro en nuestro país, al no contar con un registro a nivel nacional que muestre la real magnitud de esta enfermedad. Es imperativo generar programas de prevención para el diagnóstico temprano del cáncer de próstata mediante el examen digito-rectal de la próstata y el dosaje del antígeno prostático específico (PSA) en sangre.

Early detection of prostate cancer in Peru is very uncommon, as patients usually arrive when the disease is locally advanced or advanced. There are no prostate cancer screening campaigns that allow us to detect this disease in early stages. The incidence rates, according to the Registry of Cancer in Metropolitan Lima, are increasing. However, there is probably an under register of cases in our country, since there are not any nation-wide records showing the real magnitude of this disease. It is imperative to develop prevention programs for the early diagnosis of prostate cancer through digital rectal exams and to perform the measurement of the prostate- specific antigen (PSA) in the blood.

Sarcoma indiferenciado pleomorfico paratesticular sincrónico con carcinoma renal / Paratesticular sarcoma with synchronous renal carcinoma

OBJETIVO: El Sarcoma Indiferenciado Pleomórfico (SIP) primario de las túnicas testiculares es raro y su sincronismo con otras neoplasias malignas de la vía urinaria más infrecuente, pudiendo complicar el estadiaje y planteamiento terapéutico. Aportamos a la literatura el caso de un paciente con diagnóstico de SIP paratesticular primario de túnicas testiculares sincrónico con Carcinoma Renal. MÉTODO: Paciente con tumor intraescrotal que fue sometido a orquiectomía radical izquierda. En los estudios de extensión de enfermedad se encontró una segunda neoplasia urológica a nivel renal. Se realizó el diagnostico histológico utilizando técnicas de inmunohistoquimica para adecuada tipificación, se evaluaron alternativas terapéuticas. Se revisa la literatura existente y se discute la misma. RESULTADO: El diagnóstico de SIP fue realizado con inmunohistoquímica, su origen paratesticular en las túnicas testiculares fue evidente en la evaluación macroscópica. Después de encontrar sincronismo a nivel renal ipsilateral, fue sometido a nefrectomía radical convencional izquierda, adrenalectomía, exéresis de remanente de cordón izquierdo y linfadenectomía paraaórtica y pélvica. Recibió quimioterapia y radioterapia adyuvante. Actualmente, a doce meses de seguimiento, se encuentra sin evidencia de enfermedad. CONCLUSIONES: Los SIP son un grupo heterogéneo con diagnóstico inmunohistoquímico de exclusión. Su manejo requiere un enfoque multidisciplinario; el tratamiento quirúrgico inicial aceptado para masas paratesticulares es la orquiectomía radical con sección alta del cordón. Aun no existe suficiente evidencia de la eficacia del tratamiento complementario con linfadenectomía, quimioterapia y/o radioterapia

OBJECTIVE: Primary undifferentiated pleomorphic sarcoma (UPS) of the testicular tunics is rare, and synchronism with other malignancies of the urinary tract is uncommon, and may complicate the staging and therapeutic approach. We report the case of a patient diagnosed with primary paratesticular UPS with synchronous Renal Carcinoma. METHODS: Patient presenting with intrascrotal tumor who underwent left radical orchiectomy. In staging work up studies a second urologic neoplasia was found in the kidney. Histological diagnosis using immunohistochemical techniques for adequate characterization was performed. Adjuvant treatment options were evaluated. We review the literature and discuss the case. RESULTS: The UPS diagnosis was performed with immunohistochemistry. Paratesticular origin from testicular tunics was evident in the macroscopic evaluation. After finding the synchronic ipsilateral renal tumor, he underwent conventional left radical nephrectomy, ipsilateral adrenalectomy, excision of remnant left cord and para-aortic and pelvic lymphadenectomy. He received chemotherapy and adjuvant radiotherapy. Currently, after twelve months of follow-up there is no evidence of disease. CONCLUSIONS: The UPS is a heterogeneous group with an exclusion immunohistochemical diagnosis. Its management requires a multidisciplinary approach; the initial surgical treatment is accepted for the paratesticular mass with high section radical orchiectomy. Although there is insufficient evidence of the efficacy of adjunctive lymphadenectomy, chemotherapy and/or radiotherapy

Angiomiolipoma epiteloide: una variante del angiomiolipoma renal / Epithelioid angiomyolipoma: a rare variant of renal angiomyolipoma

OBJETIVO: Presentar un caso de angiomiolipoma (AML) variante epitelioide, primario renal, su asociación con Esclerosis Tuberosa (ET) y revisión de la literatura.MÉTODOS: Presentamos el caso de un paciente varón de 12 años con antecedente de retardo en el desarrollo psicomotor, crisis epilépticas tónico clónicas y estigmas cutáneos, todo esto compatible con ET. Debuta con hematuria macroscópica y dolor abdominal, encontrándose en la tomografía tumor que compromete dos tercios superiores del riñón izquierdo. Fue sometido a nefrectomía radical izquierda. La anatomía patológica, corroborada con estudios de inmunohistoquímica informó la presencia de AML, variante epiteliode.Se reviso la bibliográfica existente sobre esta variante poco común y su comportamiento maligno.RESULTADOS: La presencia de la variante epitelial es poco frecuente pero debe tenerse en cuenta por su comportamiento maligno y por lo tanto diferente pronóstico y seguimiento comparado al AML clásico.CONCLUSIONES: El AML renal es un tumor benigno, poco común, que representa un reto para el diagnóstico clínico e histopatológico. A pesar del gran tamaño que puede alcanzar, la bilateralidad, la multiplicidad de las lesiones y/o el compromiso linfático regional, no se ha demostrado su potencial maligno. Sin embargo, en los últimos años se ha descrito la variante epitelioide, entidad rara de comportamiento agresivo, difícil caracterización histológica y pobre pronóstico(AU)

OBJECTIVE: We present a case of primary renal epithelioid angiomyolipoma, its association with tuberous sclerosis and review the literature.METHODS: We present the case of a 12 year-old male with past medical history of tuberous sclerosis, characterized by developmental delay, tonic and clonic seizures, and cutaneous abnormalities. He presented with macroscopic hematuria and abdominal pain. CT scan of the abdomen showed the presence of a left renal tumor. He underwent left radical nephrectomy. Pathologic study of the specimen showed primary renal epithelioid angiomyolipoma, corroborated by immunohistochemistry staining. Review of the literature was performed for this rare variant and its malignant potential.RESULTS: The presence of this epithelial variant is rare and must be taken into account because of its malignant potential and, thus, with different prognosis and follow up, compared to classical angiomyolipoma.CONCLUSIONS: Renal angiomyolipoma is an uncommon benign tumor, representing a challenge for clinical and pathological diagnosis. Despite the big size they can reach, as well as bilaterality, multiplicity of lesions and/or lymphatic regional involvement, its malignant potential has not been established. Nevertheless, the epithelioid variant has been described recently, a rare entity with aggressive behavior, difficult histological characterization and poor prognosis(AU)

Cancer of the penis.

BACKGROUND: Cancer of the penis is an uncommon malignancy in developed countries, but the incidence is as high as 17% of all male cancers in some undeveloped countries. The surgical management of this disease has improved due to better knowledge of risk for metastasis and newer imaging technologies to assess the regional lymph nodes. METHODS: We review the literature on incidence, etiology, pathology, clinical presentation, staging, and management of penile cancer. We present our institutional experience with 160 patients who underwent extended ilioinguinal lymph node dissection, as well as with 7 patients who underwent a modified lymph node dissection. RESULTS: Better understanding of pathologic features allow for stratification of patients into low, intermediate, or high risk for lymph node involvement. Lymphatic mapping to this stratification improves selection of patients who might benefit from lymph node dissection after excision of the primary lesion. Our experience with lymph node dissection yielded a high incidence of positive lymph nodes when lymphadenopathy was present. The recent use of a modified lymph node dissection has minimized morbidity. Current chemotherapy agents are ineffective in this disease. CONCLUSIONS: Pathologic features of the primary lesion and the incorporation of lymphatic mapping have improved the selection of patients who might benefit from lymph node dissection. The use of a modified lymph node dissection in selected patients has decreased morbidity. Effective chemotherapy agents are needed in the management of advanced penile cancer.

Plasmocitoma testicular como presentación inicial de mieloma multiple: presentación de un caso y revisión de la literatura / Testicular plasmacytoma as presentation of multiple myeloma: case report and review of the literature

OBJETIVO: Presentamos el caso de un paciente con diagnóstico de plasmocitoma testicular como presentación inicial de mieloma múltiple y realizamos la revisión de la literatura en relación a lo infrecuente de dicha patología. MÉTODOS: Paciente de sexo masculino de 63 años portador de un tumor testicular, de 3 meses de evolución, de crecimiento progresivo. Una vez evaluado clínicamente y con estudios de ayuda diagnóstica fue sometido a orquiectomía radical. RESULTADO: La anatomía patológica reveló la presencia de células redondas, algunas de aspecto plasmocítico; el estudio inmunohistoquímico concluyó que era Plasmocitoma. Estudios de extensión de enfermedad mostraron lesiones líticas redondeadas diseminadas en los huesos de la bóveda del cráneo. Los estudios de médula ósea, así como la biopsia de hueso demostraron infiltración por neoplasia de células plasmáticas en más del 90%, consistente con el diagnóstico de Mieloma Múltiple. Paciente recibe el tratamiento respectivo, presentando progresión de enfermedad y posteriormente fallece. CONCLUSIONES: El plasmocitoma solitario es una lesión poco frecuente que representa sólo el 6% de todas las neoplasias de células plasmáticas. El compromiso testicular por esta enfermedad constituye un evento inusual, estimado en el 2% de los casos. Aunque éste es generalmente un hallazgo de autopsia, carente de expresión clínica, en raras ocasiones, como en el presente caso, puede constituir la primera manifestación de un mieloma múltiple o excepcionalmente ser la única localización de una neoplasia de células plasmáticas. Hasta la fecha son pocos los reportes publicados en la literatura y éste constituye un aporte más al conocimiento del mismo(AU)

OBJECTIVE: We present the case of a patient with testicular plasmacytoma as initial presentation of multiple myeloma, and we carry out a literature review of this uncommon pathology. METHODS: 63 year-old male who consulted for a testicular mass for three months. After clinical and diagnostic studies he underwent radical orchiectomy. RESULTS: Pathologic study of the specimen revealed the presence of round cells, some with plasmocytic aspect. Immunohistochemical studies gave the final diagnosis of plasmacytoma. Studies on disease extension showed rounded lytic lesions spread over the vault of the skull bones. Bone marrow studies, as well as bone biopsy showed infiltration by plasma cell neoplasia in more than 90%, consistent with the diagnosis of multiple myeloma.The patient received treatment, developing disease progression and subsequently died from the disease. CONCLUSIONS: Solitary plasmacytoma represents only 6% of all plasma cell neoplasms. Testicular presentation is an unusual event, representing 2% of cases. Although this is usually an autopsy finding, it may constitute the first manifestation of multiple myeloma or exceptionally be the unique location of a plasma cell neoplasm. To date there are few reports published in the literature. This case constitutes a contribution for the knowledge of testicular plasmacytoma(AU)