Valor pronóstico de la invasión microvascular en la predicción de la supervivencia en el carcinoma de células renales / Prognostic value of microvascular invasion in predicting survival in renal cell carcinoma

Objetivos: Evaluar el significado de la invasión microvascular y de otras variables clínicas e histológicas como factores predictivos de supervivencia libre de progresión y supervivencia cáncer-específica de pacientes con carcinoma renal tras cirugía. Material y métodos: Se realizó un estudio analítico retrospectivo sobre 238 pacientes consecutivos con carcinoma renal sometidos a cirugía radical o parcial entre 1990 y 2006, incluyendo tanto casos de enfermedad localizada como aquellos con afectación locorregional o con enfermedad metastásica a distancia en el momento del diagnóstico (pT1-4; N0-1; M0-1). Se evaluó la supervivencia libre de progresión y la supervivencia cáncer-específica tras un seguimiento medio de 75 meses (rango: 1-189). Las variables analizadas incluyeron: edad, sexo, tamaño tumoral, clasificación TNM 2010, gradación nuclear, subtipo histológico e invasión microvascular. Resultados: Se evidenció existencia de invasión microvascular en 79 casos (33,2%). La presencia de invasión microvascular tumoral en el estudio histológico se asoció estadísticamente con la edad (p = 0,010), el tamaño tumoral (p = 0,000), el grado de Fuhrman (p = 0,000), el estadio pT 2010 (p = 0,000), el estadio N 2010 (p = 0,000) y el estadio M 2010 (p = 0,000). En el análisis múltiple las variables que finalmente se mostraron como factores predictores de supervivencia libre de progresión fueron el sexo, el grado de Fuhrman, el estadio pT y el tipo histológico, mientras que lo fueron para supervivencia cáncer específica el sexo, el grado de Fuhrman, el estadio pT 2010, el estadio M 2010, el tipo histológico y la invasión microvascular. Conclusiones: Los resultados de nuestro estudio muestran que la invasión microvascular es un factor predictor de supervivencia cáncer-específica en pacientes con carcinoma renal (AU)

Objective: To assess microvascular tumor invasion and other clinical and histological parameters as potential prognostic factors in surgically treated renal cell carcinoma. Materials and methods: Surgical specimens from 238 consecutive patients who underwent radical or partial surgery between 1990 and 2006 were retrospectively evaluated. The series included clinically localized or metastatic renal cell carcinoma (pT1-4; N0-1; M0-1). Disease-free and cancer-specific survival assessments were the end points with median follow-up of 75 months (range 1-189 months). Variables studied included: age, sex, tumor size, TNM 2010 classification, Fuhrman grade, histological subtype and microvascular tumor invasion. Results: Microvascular tumor invasion was observed in 79 patients (33,2%) and was significantly associated with age (P =0 .010), tumor size (P =0 .000), Fuhrman grade (P = 0.000), pT stage 2010 (P = 0.000), N stage 2010 (P =0 .000) and M stage 2010 (P = 0.000). Multivariate analyses determined that sex, Fuhrman grade, pT stage 2010 and histological subtipe were independent prognostic factors of disease-free survival, while sex, Fuhrman grade, pT stage 2010, M stage 2010, histological subtype and microvascular invasion were prognostic factors for cancer-specific survival. Conclusions: Our study shows that microvascular tumor invasion is an independent prognostic factor for cancer-specific survival in surgically treated patients with renal cell carcinoma (AU)

Prognostic value of microvascular invasion in predicting survival in renal cell carcinoma.

OBJECTIVE: To assess microvascular tumor invasion and other clinical and histological parameters as potential prognostic factors in surgically treated renal cell carcinoma. MATERIALS AND METHODS: Surgical specimens from 238 consecutive patients who underwent radical or partial surgery between 1990 and 2006 were retrospectively evaluated. The series included clinically localized or metastatic renal cell carcinoma (pT1-4; N0-1; M0-1). Disease-free and cancer-specific survival assessments were the end points with median follow-up of 75 months (range 1-189 months). Variables studied included: age, sex, tumor size, TNM 2010 classification, Fuhrman grade, histological subtype and microvascular tumor invasion. RESULTS: Microvascular tumor invasion was observed in 79 patients (33,2%) and was significantly associated with age (P=.010), tumor size (P=.000), Fuhrman grade (P=.000), pT stage 2010 (P=.000),N stage 2010 (P=.000) and M stage 2010 (P=.000). Multivariate analyses determined that sex, Fuhrman grade, pT stage 2010 and histological subtipe were independent prognostic factors of disease-free survival, while sex, Fuhrman grade, pT stage 2010, M stage 2010, histological subtype and microvascular invasion were prognostic factors for cancer-specific survival. CONCLUSIONS: Our study shows that microvascular tumor invasion is an independent prognostic factor for cancer-specific survival in surgically treated patients with renal cell carcinoma.

Loss of heterozygosity at 9q32-33 (DBC1 locus) in primary non-invasive papillary urothelial neoplasm of low malignant potential and low-grade urothelial carcinoma of the bladder and their associated normal urothelium.

Tumour recurrence has a major impact on patients with non-invasive papillary urothelial tumours of the bladder. To explore the role of DBC1 (deleted in bladder cancer 1 locus), a candidate tumour suppressor gene located at 9q32-33, as prognostic marker we have performed loss of heterozygosity (LOH) testing in 49 patients with primary papillary urothelial tumours and associated normal urothelium. Data from the 38 tumours and 11 specimens of normal urothelium that were informative in the LOH study (D9S195 marker) showed that LOH in urothelium (45.4%) but not in non-invasive tumours (60.5%) was associated with tumour recurrence (p = 0.026) but not to grade or progression. Also, tumours whose normal urothelium had LOH were larger (p = 0.020) and showed cyclin D1 over-expression (p = 0.032). Non-significant increased expression of p53, p21Waf1, apoptotic index and tumour proliferation, and decreased expression of p27Kip1 or cyclin D3 also characterized tumours whose normal urothelium had LOH. The expression of these G1-S modulators, apoptotic index and tumour proliferation was more heterogeneous in papillary urothelial tumours, irrespective of having retained heterozygosity or LOH. Also, Bax expression decreased in papillary urothelial tumours having LOH (p = 0.0473), but Bcl-2 was unrelated to LOH status. In addition, FGFR3 protein expression decreased in LOH tumours (p = 0.036) and in those having LOH in their normal urothelium (p = 0.022). FGFR3 immunohistochemical expression was validated by western blot in selected cases. The survival analysis selected LOH in normal urothelium as a marker of disease-free survival (log-rank 5.32, p = 0.021), progression-free survival (log-rank 3.97, p = 0.046) and overall survival (log-rank 4.26, p = 0.038); LOH in tumours was significant in progression-free survival (log-rank 3.83, p = 0.042). It is concluded that LOH at the DBC1 locus in normal urothelium seems to be relevant in the prognosis of non-invasive papillary tumours of the bladder via selecting cases with increased proliferation, frequent alterations of the G1-S phase modulators, and decreased FGFR3 protein expression.

Clasificación de la OMS 2004 para los tumores vesicales: resumen y comentarios / The 2004 who classification of bladder tumors: a summary and commentary

Los puntos clave de la última clasificación de la OMS para los tumores uroteliales no invasivos son los siguientes: la descripción de las categorías ha aumentado para mejorar su reconocimiento: los tumores con particular buen pronóstico (neoplasia papilar urotelial de bajo potencial maligno) no deben ser etiquetados como 'cáncer'; esto evita el uso de una gradación ambigua tal como grado 1/2 o 2/3 (como se hacía en la clasificación de la OMS de 1973); el grupo de los tumores no invasivos de alto grado es bastante grande pues contiene todos los tumores con propiedades biológicas similares a las de los carcinomas invasivos, e igualmente un alto nivel de inestabilidad genética. Este esquema es el que se propone para sustituir a la clasificación de la OMS de 1973, pero no debe invalidarse definitivamente, y usarse conjuntamente con la nueva clasificación de 2004 hasta que esta última esté lo suficientemente validada

The Key points of the latest World Health Organization (WHO) classification of non-invasive urothelial tumors are the following: the description of the categories has been expanded to improve their recognition: a tumor with particularly good prognosis (papillary urothelial neoplasm of low malignant potential) no longer carries the label of 'cancer'; it avoids the use of ambiguous grading as grade 1/2 o 2/3 (as done in the 1973 WHO classification); the group of non-invasive high-grade carcinoma is large enough to virtually contain all those tumors having biological properties similar to those seen in invasive urothelial carcinoma, and a similarly high level of genetic instability. This scheme is meant to replace the 1973 WHO classification, but the use of both the 1973 and the latest WHO classification is recommended until the latter is sufficiently validated

[The 2004 WHO classification of bladder tumors: a summary and commentary]. / Clasificación de la OMS 2004 para los tumores vesicales: resumen y comentarios.

The Key points of the latest World Health Organization (WHO) classification of non-invasive urothelial tumors are the following: the description of the categories has been expanded to improve their recognition: a tumor with particularly good prognosis (papillary urothelial neoplasm of low malignant potential) no longer carries the label of "cancer"; it avoids the use of ambiguous grading as grade 1/2 o 2/3 (as done in the 1973 WHO classification); the group of non-invasive high-grade carcinoma is large enough to virtually contain all those tumors having biological properties similar to those seen in invasive urothelial carcinoma, and a similarly high level of genetic instability. This scheme is meant to replace the 1973 WHO classification, but the use of both the 1973 and the latest WHO classification is recommended until the latter is sufficiently validated.

Cyclin D3 expression in primary Ta/T1 bladder cancer.

Cyclin D3 deregulation has recently been reported in bladder cancer but its prognostic significance remains uncertain. A cohort of 159 patients with stage Ta or T1 primary bladder tumours was investigated to determine the significance of cyclin D3 expression in association with other G1-S phase regulators of the cell cycle (p53, p21Waf1, p27kip1, cyclin D1), including tumour proliferation (ki67-MIB1); its association with conventional clinicopathological parameters; and the relationship between cyclin D3 and loss of heterozygosity (LOH) at the 9p21 (p16INK4a locus) chromosome region. The end point of the study was progression-free survival. Cyclin D3, other G1-S phase regulators, and tumour proliferation were investigated by immunohistochemistry and measured by the grid-counting method. To validate the immunohistochemical expression, cyclin D3 was additionally assessed by western blotting in selected cases. LOH at the 9p21 chromosome region (marker D9S171) was assessed in 125 cases using an AB Prism 310 genetic analyser and a set of microsatellite fluorescence-labelled primers. Cyclin D3 overexpression was related to larger tumour size (>5 cm; p < 0.0001) and high tumour proliferation (>10%; p = 0.025). Mean cyclin D3 expression increased with 2004 WHO grading categories in stage Ta (p = 0.035, ANOVA) and stage T1 (p = 0.047, t test) tumours. Cyclin D3 was not related to other clinicopathological parameters, G1-S phase modulators, or 9p21 LOH. Cox's multivariate analysis selected cyclin D3 as an independent predictor of progression-free survival (p = 0.0012, relative risk (RR) = 5.2366) together with tumour size (p = 0.0115, RR = 4.4442) and cyclin D1 (p = 0.0065, RR = 3.3023). Cyclin D3 expression had the highest risk ratio. Our results suggest that expression of cyclin D3 is relevant to the progression-free survival of patients with Ta/T1 bladder carcinomas.

Ki-67 MIB1 labelling index and the prognosis of primary TaT1 urothelial cell carcinoma of the bladder.

AIMS: To evaluate whether ki-67 labelling index (LI) has independent prognostic value for survival of patients with bladder urothelial tumours graded according to the 2004 World Health Organisation classification. METHODS: Ki-67 LI was evaluated in 164 cases using the grid counting method. Non-invasive (stage Ta) tumours were: papilloma (n = 5), papillary urothelial neoplasia of low malignant potential (PUNLMP; n = 26), and low (LG; n = 34) or high grade (HG; n = 15) papillary urothelial carcinoma. Early invasive (stage T1) tumours were: LG (n = 58) and HG (n = 26) carcinoma. Statistical analysis included Fisher and chi2 tests, and mean comparisons by ANOVA and t test. Univariate and multivariate survival analyses were performed according to the Kaplan-Meier method with log rank test and Cox's proportional hazard method. RESULTS: Mean ki-67 LI increased from papilloma to PUNLMP, LG, and HG in stage Ta (p<0.0001) and from LG to HG in stage T1 (p = 0.013) tumours. High tumour proliferation (>13%) was related to greater tumour size (p = 0.036), recurrence (p = 0.036), progression (p = 0.035), survival (p = 0.054), and high p53 accumulation (p = 0.015). Ki-67 LI and tumour size were independent predictors of disease free survival (DFS), but only ki-67 LI was related to progression free survival (PFS). Cancer specific overall survival (OS) was related to ki-67 LI, tumour size, and p27kip1 downregulation. Ki-67 LI was the main independent predictor of DFS (p = 0.0005), PFS (p = 0.0162), and cancer specific OS (p = 00195). CONCLUSION: Tumour proliferation measured by Ki-67 LI is related to tumour recurrence, stage progression, and is an independent predictor of DFS, PFS, and cancer specific OS in TaT1 bladder urothelial cell carcinoma.

Prognostic factors in stage T1 grade 3 bladder cancer survival: the role of G1-S modulators (p53, p21Waf1, p27kip1, Cyclin D1, and Cyclin D3) and proliferation index (ki67-MIB1).

OBJECTIVE: To determine the prognostic value of a subset of regulators of the transition from G1-to-S phase of cell cycle in stage T1 grade 3 bladder cancers. METHODS: Fifty-one such cases were investigated to determine the significance on patient's survival of p53, p21Waf1, p27Kip1, Cyclin D1, Cyclin D3, and ki67-MIB1 (proliferation index). The statistical analysis included Kaplan-Meier methodology with Log-rank test and Cox' proportional hazard analysis. RESULTS: Tumor size (p=0.0034), and the labeling index of ki67-MIB1 (p=0.0034), p53 (p=0.0332), p27kip1 (p=0.0059) and Cyclin D1 (p=0.0103) were associated to disease-free survival. Progression-free survival was related to tumor size (p<0.0001), ki67 (p=0.0163), p53 (p=0.0041), p27kip1 (p=0.0161), Cyclin D1 (p<0.0001) and Cyclin D3 (p<0.0001). Patient's overall survival was associated to Cyclin D3 (p<0.0001), p53 (p=0.0017), p21Waf1 (p=0.0142), Cyclin D1 (p<0.0001), ki67-MIB1 (p=0.0450), and tumor size (p=0.0296). Down-regulation of p27kip1 and Cyclin D3 over-expression (disease-free), over-expression of p53, Cyclin D1 and Cyclin D3 (progression-free), and over-expression of Cyclin D3 (overall survival) were independent predictors by Cox's multivariate analysis. Down-regulation of p27kip1 (p<0.001, R.R. 0.997, 95%C.I. 0.995-0.999), and over-expression of Cyclin D1 (p<0.001, R.R. 1.009, 95%C.I. 1.004-1.014) and Cyclin D3 (p=0.005, R.R. 1.013, 95%C.I. 1.004-1.022) were the main independent predictors. CONCLUSION: Down-regulation of p27kip1 and over-expression of Cyclin D1 and Cyclin D3 might be relevant predictors of survival in stage T1 grade 3 bladder cancers, thus selecting a group of patients at higher risk of malignant behavior.

[Review of cut-off points between stages T1 and T2 in the 1997 TNM classification of renal carcinoma]. / Revisión del punto de corte entre los estadios T1 y T2 en la clasificación TNM del carcinoma renal de 1997.

OBJECTIVE: We retrospectively review the patients treated at our institution for renal cell carcinoma (RCC). We compare the patients classified in TNM state T1N0M0 in the 1997 revision with the 1992 one in order to determine survival differences. We divide patients in three size related groups and compare its survival rates. MATERIAL AND METHODS: We review 168 surgically treated patients. 72 of them were classified into T1N0M0 stage. We compare cancer-free survival in patients included in 1997 and 1992 T1 stage. We divide patients in three groups: 1-3 cm, 3-5 cm, 5-7 cm and compare respective cancer-free survival. RESULTS: There is a survival difference between T1(1997)-T2(1992) (p = 0.478). There is an inferior survival in size group 5-7 cm compared with 1-3 cm and 3-5 cm ones (p = 0.02/0.0465). CONCLUSIONS: In our patients, 1997 revision of T1 size supposes a descent of cancer-free survival compared with 1992 one. We consider a better stage limit under 5 cm, instead of actual 7 cm.

Revisión del punto de corte entre los estadios T1 y T2 en la clasificación TNM del carcinoma renal de 1997 / Cut-off point revision between 1997 TNM classification stages T1 and T2 o renal carcinoma

OBJETIVO: Realizamos un estudio retrospectivo de los pacientes tratados en nuestra institución por carcinoma de células renales (CCR). Comparamos los pacientes clasificados en el estadio T1N0M0 según la revisión TNM de 1997 con la clasificación según la revisión de 1992 para establecer diferencias de supervivencia. Comparamos diferentes cortes por tamaño tumoral y valoramos su implicación en la supervivencia. MATERIAL Y MÉTODOS: Análisis retrospectivo de una serie de 168 pacientes intervenidos por CCR, de ellos 72 clasificados en estadio T1N0M0. Comparamos supervivencia según las dos últimas revisiones TNM y en tres grupos de tamaño: 1-3 cm, 3-5 cm y 5-7 cm. RESULTADOS: Hallamos menor supervivencia en los pacientes T11997 (p=0,0478) y en grupo de tamaño 5-7 cm, con respecto al 1-3 cm (p=0,02) y al de 3-5 cm (p=0,0465).CONCLUSIONES: En nuestra serie, la revisión de 1997 en el estadio T1 supone un descenso de supervivencia. El límite en 7 cm es excesivo, lo consideramos más apropiado por debajo de 5 cm (AU)

Combined treatment with vitamin E and colchicine in the early stages of Peyronie's disease.

OBJECTIVE: To assess the effectiveness of the combination of colchicine and vitamin E (which has anti-fibrotic, anti-mitotic and anti-inflammatory effects) in modifying the early stages of Peyronie's disease, by evaluating pain relief, correction of deformities and plaque size. PATIENTS AND METHODS: In all, 45 patients were divided into two groups and treated from January 1998 to November 2001. Their mean (range) age was 53.4 (40-62) years, the time from onset of the disease < 6 months and they had penile deformity of < 30 degrees; no patient had erectile dysfunction. Twenty-two patients were given ibuprofen 400 mg/day for 6 months, whilst 23 received a combination of vitamin E 600 mg/day plus colchicine 1 mg every 12 h. Pain, plaque size and penile deformity were assessed at 6 months. RESULTS: There were no statistically significant differences between the groups at baseline in age, time from onset of the disease until the initial evaluation or plaque size. Although the proportion of patients reporting pain relief was higher amongst those receiving colchicine plus vitamin E (91% vs 68%) this was not significantly different, but differences in plaque size and penile curvature were significant. CONCLUSIONS: The use of colchicine plus vitamin E during the early stages of Peyronie's disease (time from onset < 6 months) in patients with penile curvature of < 30 degrees and no erectile dysfunction is an effective and well-tolerated way to stabilize the disease. A more extensive study is needed, comparing these results with other oral therapies.

[Encrusted pyelitis. Lithiasic disease with infectious etiology]. / Pielitis incrustada. Una enfermedad litiásica de etiología infecciosa.

We report on two new cases of encrusted pielitis, a lithiasic disease of infectious ethiology--Corynebacterium of D group-. The clinic diagnostic is difficult and this disease develops in immunosuppressed patients, mainly in renal transplanted ones. One of our two cases is diagnosed in a patient with a transplanted kidney and the other one develops the disease within her native kidneys. We remark on the clinic features and therapeutic options.

Pielitis incrustada. Una enfermedad litiasica de etiologia infecciosa / Encrusted pyelitis. A renal lithiasic disease of infectious ethiology

Presentamos dos nuevos casos de pielitis incrustada, una enfermedad litiásica de etiología infecciosa relacionada con el Corynebacterium del grupo D. El diagnóstico clínico es difícil y se desarrolla en enfermos inmunodeprimidos, sobre todo en aquellos sometidos a trasplante renal. Nuestros pacientes desarrollan la enfermedad en un caso en un enfermo trasplantado y en el otro en riñones no trasplantados. Detallamos las características clínicas y las opciones terapéuticas (AU)

Diferencias clínico-patológicas entre neoplasia vesical de bajo potencial maligno y carcinoma de bajo grado / Clinicopathological differences between papillary neoplasm of low malignant potential and low grade papillary carcinoma

OBJETIVO: Determinar si la subdivisión morfológica de los tumores vesicales de grado I entre neoplasia papilar de bajo potencial maligno (BPM) y cáncer vesical de bajo grado, tiene correlación con la evolución clínica y supervivencia del paciente. MATERIAL Y MÉTODOS: Se revisan 257 tumores vesicales superficiales consecutivos sometidos a resección transuretral entre 1990 y 1995 en el HU Reina Sofía de Córdoba, y se reevalúan según los criterios de la nueva clasificación de consenso de la OMS/ISUP de 1998. Se obtienen 12 pacientes con papiloma urotelial, 51 pacientes con neoplasia papilar BPM, 43 pacientes con cáncer vesical de bajo grado Ta, 65 pacientes con cáncer vesical de bajo grado T1 y 37 pacientes con cáncer vesical de alto grado. Once pacientes son reevaluados como T2 y 38 (14,8 por ciento) son perdidos de control. Se revisan los historiales clínicos de cada paciente con un seguimiento mínimo de 5 años, determinando las recidivas y progresiones dentro de cada grupo. Se comparan los resultados entre grupos con el test Chi-Cuadrado y se evalúan los factores de riesgo para la recidiva y progresión mediante análisis multivariado (Odds ratio). La función supervivencia se representa con las tablas de Kaplan y Meier, comparándolas con el test log rank. RESULTADOS: No encontramos diferencias entre ambos grupos con respecto a la edad ni distribución por el sexo. Las diferencias en el número de tumores no son significativas, mientras que el tamaño tumoral medio es significativamente mayor en el grupo "cáncer de bajo grado". En cuanto a los factores de riesgo para la recidiva y progresión de la enfermedad, sólo hallamos significativo el tamaño tumoral. Sorprendentemente, el uso de quimioterapia endovesical parece tener influencia en la aparición de recidiva. No encontramos diferencias en las tasas de recidiva y progresión entre ambos grupos, aunque los porcentajes son siempre mayores para el grupo "cáncer vesical de bajo grado". CONCLUSIÓN: La división de los tumores vesicales de bajo grado (G-I) entre "neoplasia de bajo potencial maligno" y "cáncer de bajo grado" sí presenta suficientes diferencias clínicas como para considerarlas entidades patológicas distintas. Sólo el tamaño tumoral aumentado es factor pronóstico dentro de cada grupo. Creemos que el uso de quimioterapia endovesical no está justificado en este tipo de tumores (AU)

[Clinico-pathologic differences between bladder neoplasm with low malignant potential and low-grade carcinoma]. / Diferencias clínico-patológicas entre neoplasia vesical de bajo potencial maligno y carcinoma de bajo grado.

OBJECTIVE: To determine if the morphologic subgrouping of grade I bladder tumors between papillary neoplasm of low malignant potential and low grade papillary carcinoma is of clinical and survival value. MATERIAL AND METHODS: All 257 consecutive patients diagnosed of superficial bladder cancer between 1990 and 1995 in HU Reina Sofia of Cordoba were reviewed and further reclassified according to WHO/ISUP consensus classification of urothelial neoplasms of the bladder. Of the tumors 12 were urothelial papilloma, 51 were papillary neoplasm of low malignant potential, 43 were low grade papillary carcinoma Ta, 65 were low grade papillary carcinoma T1 and 37 were high grade papillary carcinoma. Eleven patients were reevaluated as T2 tumors and 38 (14.8%) were lost of control. All patients were reviewed with a follow-up at least of 5 years. We compare the results between groups with Fisher test and the risk factors for recurrence and progression are analyzed by multivariate analysis (Odds ratio). The survival function was calculated using Kaplan-Meier estimates and compared with the log-rank test. RESULTS: There are no differences between groups respect the age or sex distribution. The differences in the multiplicity are not significant and only the mean size is higher in papillary low grade carcinoma. About the risk factors for recurrence and progression of the disease, only is significative the tumor size. Rarely, the use of chemotherapy seems to play a role in the recurrence. There are no differences in recurrence and progression between the groups, although the percentages are always higher in the papillary low grade carcinoma group. CONCLUSIONS: There are enough clinical differences between the two groups and we consider them as distinct pathologic entities. Only the higher tumoral size is prognostic factor in each group. We think that the use of chemotherapy must be avoided in this low grade bladder tumors.

[Molecular biology in bladder cancer]. / Biología molecular en el cáncer vesical.

Progress of molecular biology with regard to etiopathogeny of tumours in general, and cancer of the bladder in particular, is taking place at such a vertiginous pace that practising urologists find themselves overwhelmed in terms of their ability to learn and keep updated in so complex a subject. The understanding of certain molecular factors with critical influence on the formation, growth and progression of a tumour of the bladder, is forcing us to make unbiased assessments on the role they will play in the evolution and survival of this neoplasia. It is anticipate they will be much more reliable than traditionally established morphological factors such as grade and stage. We also include a literature review with an analysis and elucidation of the role played by oncogenes, tumor suppressor genes, vascular density markers, telomerase etc., in the formation and growth of cancer of the bladder and their likely relationships with already established clinico-pathological factors.

Hemorragia subepitelial de pelvis renal (lesión de Antopol-Goldman). Presentación de cuatro casos y revisión de la literatura / Subepithelial hemorrhage of the renal pelvis (Antopol-Goldman lesion). Four new cases and review of the literature

OBJETIVOS: El hematoma subepitelial de pelvis renal (Lesión de Antopol-Goldman) es una rara entidad que preferentemente se diagnostica en la clínica como una lesión neoplásica. MÉTODOS: Presentamos 4 casos nuevos de hematoma subepitelial de pelvis renal diagnosticados en nuestro hospital desde 1989. RESULTADOS: Nuestros casos se presentaron clínicamente por hematuria y dolor lumbar, preferentemente en el lado izquierdo (3 de 4 ). Tras nefrectomía, macroscópicamente se observó en todos los casos un hematoma subepitelial de extensión variable pudiendo llegar a ocupar la pelvis y cálices renales, asociándose a cambios histológicos de hidronefrosis, infarto cortical, renomegalia o angioma renal. Adicionalmente, dos de nuestros pacientes se presentaron por dilatación del sistema pielocalicial, y un tercero presentó carcinoma urotelial de vía urinaria inferior, siendo por tanto la lesión de Antopol-Goldman un hallazgo incidental. En el caso restante se identificó como causa del hematoma pélvico la presencia de hemangiomas renales múltiples. CONCLUSIONES: El diagnóstico preoperatorio de la lesión de Antopol-Goldman es difícil aunque debería incluirse como diagnóstico diferencial todos aquellos casos con hematuria y alteraciones de pelvis renal en las técnicas de imagen, pues su diagnóstico podría implicar un tratamiento conservador con pieloplastia o nefrectomia parcial. (AU)

Neoplasia papilar urotelial de bajo potencial maligno. Estudio retrospectivo / Papillary urothelial neoplasm of low malignant potential. Retrospective study

El conocimiento de la evolución y supervivencia a largo plazo de las neoplasias papilares uroteliales de bajo potencial maligno de vejiga es aún muy limitado dada la reciente aparición de esta terminología. MATERIAL Y MÉTODOS: Se revisan y reclasifican todos los carcinomas vesicales superficiales tratados en el HRU Reina Sofía de Córdoba entre 1990 y 1995. Encontramos 50 pacientes que reúnen los criterios de neoplasia papilar urotelial de bajo potencial maligno según la nueva clasificación de la OMS/ISUP de 1998 para las lesiones vesicales. Ningún paciente tenía historia previa o coexistente de displasia urotelial, carcinoma in situ o carcinoma urotelial invasivo. RESULTADOS: La edad media al diagnóstico fue de 62,08 años (rango 32-85). De los 50 pacientes, 44 fue-ron varones y 6 mujeres. En todos los casos hubo ausencia de neoplasia en el tracto urinario superior. En 39 pacientes (78 por ciento) hubo 2 o menos implantes tumorales y en 11 casos (22 por ciento) 3 o más implantes del tumor primario. El tamaño tumoral medio fue de 2,26 cm (rango 1-5). Recidivaron sin progresión 17 (34 por ciento) de los 50 pacientes y progresaron 2 pacientes (4 por ciento). La supervivencia media fue de 78 meses (rango 33-117), falleciendo 2 pacientes por cáncer vesical. CONCLUSIONES: Los pacientes con neoplasia papilar urotelial de bajo potencial maligno tienen un riesgo incrementado de recurrencia local, progresión y muerte por cáncer vesical por lo que han de ser sometidos a un estrecho seguimiento (AU)

[Primary malignant melanoma of the female urethra. Report of a case]. / Melanoma maligno primario de uretra femenina. A propósito de un caso.

Primary malignant melanoma of the female urethra is a rare tumour with great agressivity and poor prognosis. An early diagnosis may benefit of radical surgery and adjuvant immunotherapy with curative effect. We present a sixty-five years old female with a malignant melanoma of urethra and a secondary additional melanoma in vulva, that was treated with both radical ureterectomy and vulvectomy. A bilateral inguinal lymphadenectomy and immunotherapy with alpha-interferon were added. The patient is free of disease one year postoperatively.

Biología molecular en el cáncer vesical / Molecular biology in bladder cancer

El desarrollo de la biología molecular referido a la etiopatogenia de los tumores en general, y del cáncer vesical en particular, se produce a una velocidad vertiginosa que supera ampliamente la capacidad de aprender y estar al día en materia tan compleja para el urólogo de batalla.El conocimiento de factores moleculares de influencia decisiva en la formación, desarrollo y progresión del cáncer vesical, nos obliga a valorar en su justa medida el papel que tienen o tendrán en la evolución y supervivencia de este tumor. Se prevée ya de antemano, que su fiabilidad deberá ser mucho mayor que los factores clásicamente establecidos morfológicos, es decir, el grado y el estadio.Realizamos una revisión bibliográfica, analizando y explicando el papel que juegan los oncogenes, genes de supresión tumoral, marcadores de densidad vascular, telomerasa, etc., en la formación y desarrollo del cáncer vesical, y sus posibles relaciones con factores clínicopatológicos ya establecidos (AU)