[Prostate cyst at the midline in a patient with a renal transplantation]. / Quiste prostático de línea media en paciente trasplantado renal.

Cystic lesions at the midline of the prostate are uncommon and they are considered as congenital disorders. Is generally accepted that active treatment should be instituted only in symptomatic patients and watchful waiting in asymptomatic ones. The most common active treatment is minimally invasive surgery by puncture-aspiration or endoscopic unroofing. We are attaching an inmunosupressed patient because of a renal transplantation in which we provided an active treatment by puncture-aspiration of the cystic lesion in spite of being asymptomatic.

Initial experience with abiraterone acetate in patients with castration-resistant prostate cancer.

OBJECTIVE: To describe the results obtained in 25 males with metastatic castration-resistant prostate cancer (MCRPC) treated with abiraterone (AA). A comparative analysis of abiraterone effectiveness and safety between our results and data published in the literature was conducted. MATERIAL AND METHOD: Bi-institutional prospective analysis of 25 consecutive patients with MCRPC undergoing treatment with abiraterone, with a mean follow-up 7.9 (3-15) months was carried out. Treatment effectiveness and safety analyses regarding baseline characteristics of patients (age, prior treatments, basal PSA, performance status, pain, metastasis) were conducted. RESULTS: At 13.6 months of follow-up, the overall survival is 80% (CI 95%: 11.8-15.4). Clinical and radiological-free progression survival is 9.5 ± 1 months (CI 95%: 7.7-11.3) and biochemical response is 6.8 ± 1 months (CI 95%: 5-8.7). Only the treatment with chemotherapy impaired significantly the response time to AA [6.4 months for radiological-free progression survival (CI 95%: 4.2-8,6) and 4.3 months for biochemical-free progression survival (CI 95%: 2.6-6)]. The incidence of adverse drug events was 36%, all of them grade 1-2/4 and, in no case, suspension or reduction of the dose of AA was needed. CONCLUSIONS: The treatment with AA has been effective in our series, with a tolerability considerably higher than what other studies published.

Early diagnosis and treatment of renal cell carcinoma of native kidney in kidney transplantation.

BACKGROUND: The frecuency of malignancies in renal transplant (RT) patients is increasing. Renal cell carcinoma (RCC) of native kidneys is one of the most frequent and its outcome can be more aggressive than in general population. OBJECTIVE: To evaluate the incidence and prognosis of RCC in renal transplant patients followed in our transplantation unit. METHODS: Between January 1997 and December 2009, 683 patients underwent kidney transplant at our hospital. Ultrasonography of the native kidneys was annually performed in all renal transplant patients. When suspect solid masses were found at ultrasonography, patients underwent computed tomography. If the suspicion was confirmed, nephrectomy was performed. RESULTS: 14 radical nephrectomies were performed in 12 patients due to suspect CCR. In 11 nephrectomies (corresponding to 9 patients), anatomopathologic diagnosis was CCR (incidence 1.5%). Histologic stage was T1N0M0 in all cases. In the other 3 RT, the diagnosis was complicated renal cyst. Those patients without carcinoma had polycystic kidney disease. The time on dialysis before CCR diagnosis was 36.7 ± 24.3 months and the interval between RT and diagnosis was 39 ± 25.8 months. After a mean follow-up of 58.6 ± 38.6 months, the outcome of all cases has been excellent, without tumor recurrence. CONCLUSIONS: Annual renal ultrasonography plays a key role in the early diagnosis of CRR. The early treatment of this pathology is associated with an excellent prognosis in RT patients.

[Nephritic colic caused by periureteral fibrosis resulting from metastasis from lobular carcinoma of the breast]. / Cólico nefrítico por fibrosis periureteral de metástasis de carcinoma lobulillar de mama.

OBJECTIVE: To report a rare case of renoureteral colic in a patient with a solitary left kidney, due to fibrosis around the renal pelvis and ureter from metastatic lobular carcinoma of the breast. METHODS/RESULTS: A 45-year-old patient consulted at the emergency services for pain in the left renal fossa that irradiated to the genital organs. Patient evaluation showed lid edema and oliguria. An abdominal ultrasound scan demonstrated left hydronephrosis. The cause of the obstruction could not be determined by imaging techniques. Exploratory lumbotomy was performed and the pelvis and ureter were released from the fibrotic covering. The histological analysis showed infiltration of the ureteral adventitia arising from lobular breast carcinoma. CONCLUSIONS: Retroperitoneal metastases that cause ureteral obstruction usually occur two years following diagnosis of the primary tumor. This is one of the few cases of ureteral obstruction from metastatic lobular carcinoma of the breast reported in the literature. Unlike the other cases, however, our patient showed a complicated genitourinary malformation.