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

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

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

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

[Giant retroperitoneal liposarcoma]. / Liposarcoma retroperitoneal gigante.

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

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

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

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

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

[Primary renal lymphoma]. / Linfoma renal primario.

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

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

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

[Hypercalcemia, leukemoid reaction, and thrombocytosis as paraneoplastic presentation of transitional cell carcinoma of the kidney]. / Hipercalcemia, reacción leucemoide y trombocitosis como presentación paraneoplásica del carcinoma renal de células transicionales.

The most common etiologies of hypercalcemia are hyperparathyroidism or malignancy, most often of the lung, breast or hematological system, but rarely occur in transitional cell carcinoma. The appearance of this metabolic disorder and other paraneoplastic signs like leukemoid reaction or thrombocytosis is a potential marker for malignant behaviour and poor prognosis in advanced tumours. Simultaneous presentation of that three paraneoplastic signs have only been described in two patients with wellknown bladder carcinoma. Most paraneoplastic syndromes appear only during the late stages of malignancy when the diagnosis has long been established, but sometimes may be an early sign of the malignancy. We describe a case of a previously unknown infiltrating transitional cell carcinoma of the kidney without bony metastasis, that presented itself with hypercalcemia, hyperleukocytosis resembling a leukemoid reaction and thrombocytosis. We think recognizing the paraneoplastic syndrome is very important because it is an alarm sign of malignancy.

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

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

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

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

[Endoscopic treatment of ureteral lithiasis. Our experience with 360 retrograde uretero-renal endoscopies in the last ten years]. / Tratamiento endoscópico de la litiasis ureteral. Nuestra experiencia en 360 ureterorrenoscopias retrógradas en los últimos 10 años.

Presentation of results and complications obtained in 360 procedures of transuretral ureterorenoscopy (URS) in ureteral lithiasis performed in our unit from january 1990 to august 2000 in 354 patients: 55% female and 45% male. A rigid ureteroscopy Storz 10.5 Ch. was used and intracorporeal lithotripsy was necessary in 17.31% of cases. URS indications were always treatment of ureteral lithiasis, pelvic ureter localization in most cases (70.33%) being 93.05% the percentage of overall success and with a significant decrease when the calculus was located in the upper third of the ureter. Serious complications were only 3.05% of cases and endoscopic surgery was necessary in three cases of ureteral stenosis. In our experience, URS is our technique of choice for treatment of lower and medium third of the ureter where the percentage of success we have obtained were 98.99% and 95.83% respectively.

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

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

[Hypertension emergency during surgery of renal carcinoma associated with non-diagnosed pheochromocytoma]. / Emergencia hipertensiva durante la cirugía de un carcinoma renal asociado a feocromocitoma no diagnosticado.

OBJECTIVE: To present an uncommon association of renal carcinoma with an undiagnosed ipsilateral pheochromocytoma that caused severe cardiovascular disorders during surgical treatment of the renal carcinoma, and emphasize the need for careful assessment of these adrenal nodules before resection although they may appear to be clinically irrelevant. METHODS: A 61-year-old male with mild arterial hypertension controlled with drug therapy for 40 years was diagnosed as having a right renal hypernephroma and a probable adrenal adenoma by IVP, abdominal ultrasound, CT, bone scintiscan and renal arteriography. Preoperative values were within the normal limits. The patient developed severe hypertension intraoperatively, which was controlled by administration of lidocaine, nitroglycerine, sodium nitroprusside and labetalol. Surgery was interrupted and completed when the patient was stable. RESULTS: The pathological analysis showed clear cell renal adenocarcinoma and pheochromocytoma. Postoperative evaluation showed dopamine, adrenaline, noradrenaline and vanilmandelic acid were normal. A 131 MIBG scan was normal. CONCLUSION: Although an adrenal mass may appear to be clinically irrelevant, a careful study should be performed to discard a functioning tumor and to avoid the serious complications that might arise during surgery.