[Penile leiomyosarcoma: case report and bibliographic review]. / Leiomiosarcoma de pene: presentación de un caso y revisión de la literatura.

OBJECTIVE: Primary penile leiomyosarcoma is a rare entity. Since 1930 only 30 cases have been reported in the bibliography. We wanted to add a new case to the international literature, in addition to a review of all available publications on the topic from 1957. A 54-year-old patient presented with a lobulated 8x4x3 cm lesion in the balanopreputial groove over two years; he was treated initially with partial penectomy and subsequently with total penectomy We analyze the evolution, progression and adjuvant treatments of this rare pathology. METHODS/RESULTS: We report one case with its clinical presentation, diagnostic tests performed for staging, treatment and follow-up. CONCLUSIONS: The first case of penile leiomyosarcoma was described by Levi in 1930. In 1957 Ashley and Edwards reported the first case in the British literature and in 1963 Pack reported the first in the American literature. MacKenzie et al. were the first to recognize two types of leiomyosarcoma: superficial and deep. The first develop from smooth muscle cells from the superficial dermal layers of the glans penis or distal third of the penis, they are generally asymptomatic and less malignant, rarely invading deeper structures and without involvement of the urethra on physical exam. The best prognostic predictors are type of tumor at presentation (superficial vs. deep) and treatment choice, being total penectomy more effective for failures of local resections than for primary treatment of deep tumors.

Leiomiosarcoma de pene: presentación de un caso y revisión de la literatura / Penile leiomyosarcoma: case report and bibliographic review

OBJETIVO: El leiomiosarcoma primario de pene constituye una rara entidad. Desde 1930 hasta la actualidad han sido reportados solo 30 casos en la literatura mundial. Además de revisar las publicaciones disponibles al respecto desde 1957 hasta nuestros días, nosotros como objetivo quisimos añadir un nuevo caso a la literatura internacional sobre un paciente de 54 años con una lesión lobulada, de dos años de evolución a nivel del surco balanoprepucial, de 8x4x3cm., tratado con penectomía parcial inicialmente y penectomía total posterior a la misma. Analizamos evolución, progresión y tratamientos adyuvantes de esta infrecuente patología. MÉTODOS/RESULTADOS: Presentamos un caso de un paciente masculino, detallamos la presentación clínica, los exámenes complementarios utilizados para la estadificación, el tratamiento empleado y el control evolutivo. CONCLUSIONES: El primer caso de leiomiosarcoma de pene fue descripto por Levi en 1930. Luego en 1957, Ashley y Edwards reportaron el primer caso en la literatura británica y en 1963, Pack refirió el primer caso en la literatura americana. Mc Kenzie y cols., fueron los primeros en reconocer dos tipos de leiomiosarcoma, los superficiales y los profundos. Los primeros se desarrollan desde células musculares lisas de estratos superficiales dérmicos glandelares y/o tercio distal peneano, son generalmente asintomático y de menor grado de malignidad, con escasa tendencia a invadir estructuras mas profundas, y con indemnidad uretral a la exploración. Los mejores predictores pronósticos serían el tipo tumoral a la presentación (superficial vs. profundo), y el tratamiento elegido para cada caso, donde la amputación total es más efectiva para tratamientos fracasados de resecciones locales que como tratamiento primario de los tumores profundos

OBJECTIVE: Primary penile leiomyosarcoma is a rare entity. Since 1930 only 30 cases have been reported in the bibliography. We wanted to add a new case to the international literature, in addition to a review of all available publications on the topic from 1957. A 54-year-old patient presented with a lobulated 8x4x3 cm lesion in the balanopreputial groove over two years; he was treated initially with partial penectomy and subsequently with total penectomy. We analyze the evolution, progression and adjuvant treatments of this rare pathology. METHODS/RESULTS: We report one case with its clinical presentation, diagnostic tests performed for staging, treatment and follow-up. CONCLUSIONS: The first case of penile leiomyosarcoma was described by Levi in 1930. In 1957 Ashley and Edwards reported the first case in the British literature and in 1963 Pack reported the first in the American literature. MacKenzie et al. were the first to recognize two types of leiomyosarcoma: superficial and deep. The first develop from smooth muscle cells from the superficial dermal layers of the glans penis or distal third of the penis, they are generally asymptomatic and less malignant, rarely invading deeper structures and without involvement of the urethra on physical exam. The best prognostic predictors are type of tumor at presentation (superficial vs. deep) and treatment choice, being total penectomy more effective for failures of local resections than for primary treatment of deep tumors

[The rupture of the renal graft]. / Rotura del riñon trasplantado.

OBJECTIVES: The renal graft rupture (RGR) was first described in 1968; it is a severe situation, generally appearing in the immediate post-operative period. OBJECTIVES: To retrospectively analyze the incidence of renal graft rupture in the population of patients who underwent kidney transplant in the Renal Transplant Department of the Angerich Hospital. METHODS: 492 kidney transplants were performed from 1-1-1992 to 7-31-2005. 422 (85.7%) cadaver donor transplants and 70 (14.3%) live related donor transplants. RESULTS: 11 renal ruptures were observed, with a clinical picture characterized by sudden pain in the graft area, hypotension, and hematocrit descent. CT scan confirmed the diagnosis. Seven patients underwent transplant nephrectomy (one of them 24 hours after surgical repair), another two were surgically repaired successfully, and for the other two patients a conservative management with watchful waiting also resulted in graft preservation. All cases where cadaver donor drafts. CONCLUSIONS: 1) The renal graft rupture is a rare (2.8% in our series) severe complication characterized by hemodynamic instability, with no diagnostic doubts about its presentation in most cases. We use ultrasound as the diagnostic test. 2) In our series we were able to preserve 40% of the kidneys with low morbidity. 3) This complication appeared in cadaver donor kidneys in all cases (11/386; 2.8%).

[Wilms tumor in an adult patient: case report]. / Tumor de Wilms en paciente adulto presentación de un caso.

Nephroblastoma or Wilms tumor is the most common renal neoplasia in children, representing 1/5 of the malignant tumors in this group. Nevertheless, the incidence of such tumor in adults is much rarer with less than 250 cases reported. Due to the low-frequency of this pathology in adults there is not a world widely accepted treatment modality. Currently, the therapeutic options derive from the National Wilms Tumor Study (NWTS). We report a new case with the radiological images, histologic findings, outcomes and follow-up.

Tumor de Wilms en paciente adulto. Presentación de un caso / Wilms tumor in an adult patient: case report

El nefroblastoma o tumor de Wilms, es la neoplasia renal más común en niños y representa actualmente la quinta parte en tumor malignos en este grupo. Sin embargo la incidencia de dicho tumor en el adulto es mucho más rara con tan sólo menos de 250 casos reportados en la literatura. Debido a la baja frecuencia de esta patología en adultos no existe una modalidad en el tratamiento aceptada mundialmente. Actualmente las opciones terapéuticas se desprenden del National Wilms Tumor Study (NTWS). Presentamos a continuación un nuevo caso con las imágenes radiográficas, hallazgos histológicos, evolución y seguimiento

Nephroblastoma or Wilms tumor is the most common renal neoplasia in children, representing 1/5 of the malignant tumors in this group. Nevertheless, the incidence of such tumor in adults is much rarer with less than 250 cases reported. Due to the low-frequency of this pathology in adults there is not a world widely accepted treatment modality. Currently, the therapeutic options derive from the National Wilms Tumor Study (NWTS). We report a new case with the radiological images, histologic findings, outcomes and follow-up

Rotura de riñón trasplantado / The rupture of the renal graft

La rotura del injerto renal (RR) descripta por primera vez en 1968, es una situación grave que se produce habitualmente en el postoperatorio inmediato. OBJETIVO: Analizar retrospectivamente la incidencia de rotura renal ( RR) en la población de pacientes transplantados por el Servicio de Transplante Renal del Hospital Argerich. MÉTODOS: Desde el 01-01-92 al 31-07-05 se realizaron 492 transplantes renales. 422 (85,7%) de dador cadavérico y 70 (14,3%), de dador vivo relacionado. RESULTADOS: Se observaron 11 RR, estando el cuadro clínico caracterizado por dolor brusco en el área de injerto, hipotensión, descenso del hematocrito. La ecografía renal fue de utilidad al mostrar un hematoma perirrenal y retroperitoneal. La tomografía computada corroboró estpos hallazgos. Se realizaron 7 nefrectomías, (una a las 24 hs. de una reparación quirúrgica), otros 2 fueron reparados quirúrgicamente en forma exitosa y en los restantes dos pacientes se adoptó una conducta expectante que también resulto en la preservación del injerto. En todos los casos el injerto renal fue proveniente de dador cadavérico. CONCLUSIONES: 1) La rotura del injerto renal es una complicación grave, infrecuente (2 8% de nuestra población), caracterizada por compromiso hemodinámico, no ofreciendo dudas diagnósticas su presentación clínica en la mayoría de los casos. Utilizamos la ecografía como método diagnóstico complementario . 2) en nuestra casuística hemos logrado conservar el 40 % de los riñones con una baja morbilidad. 3) En todos los casos, esta complicación se presentó en pacientes que recibieron riñones provenientes de dadores cadavéricos (11/386; 2.8%)

OBJECTIVES: The renal graft rupture (RGR) was first described in 1968; it is a severe situation, generally appearing in the immediate post-operative period. OBJECTIVES: To retrospectively analyze the incidence of renal graft rupture in the population of patients who underwent kidney transplant in the Renal Transplant Department of the Angerich Hospital. METHODS: 492 kidney transplants were performed from 1-1-1992 to 7-31-2005. 422 (85.7%) cadaver donor transplants and 70 (14.3%) live related donor transplants. RESULTS: 11 renal ruptures were observed, with a clinical picture characterized by sudden pain in the graft area, hypotension, and hematocrit descent. CT scan confirmed the diagnosis. Seven patients underwent transplant nephrectomy (one of them 24 hours after surgical repair), another two were surgically repaired successfully, and for the other two patients a conservative management with watchful waiting also resulted in graft preservation. All cases where cadaver donor drafts. CONCLUSIONS: 1) The renal graft rupture is a rare (2.8% in our series) severe complication characterized by hemodynamic instability, with no diagnostic doubts about its presentation in most cases. We use ultrasound as the diagnostic test. 2) In our series we were able to preserve 40% of the kidneys with low morbidity. 3) This complication appeared in cadaver donor kidneys in all cases (11/386; 2.8%)