Hidatidosis pelviana como ejemplo de masas pelvianas de etiología dudosa / Pelvic hydatid disease as an example of pelvic masses of uncertain aetiology

Presentar dos nuevos casos de quiste hidatídico pelviano, uno con clínica de compresión local y otro asintomático. Varón de 75 años que refiere tenesmo, dificultad para la micción y defecación. Una ecografía revela que se trata de una gran masa quística pelviana que desplaza la vejiga y el rectosigma. La tomografía computarizada describe imágenes compatibles con hidatidosis y un quiste hidatídico hepático. Se interviene quirúrgicamente al paciente, y se extirpa parcialmente el quiste pelviano. El otro caso es un varón de 75 años que, en el estudio de HBP, se descubre de forma casual una hidatidosis pelviana. Se decide, al estar asintomático, vigilancia. La anatomía patológica confirma el diagnóstico en el primer caso y los hallazgos radiológicos, en el segundo. Ambos pacientes están asintomáticos. La posibilidad de hidatidosis se debe considerar en el diagnóstico diferencial de cualquier masa quística localizada en los órganos pelvianos, sobre todo en países donde la enfermedades endémica. Aunque no hay un test serológico con el 100% de especificidad, las pruebas radiológicas ayudan a confirmar el diagnóstico. La cirugía es el tratamiento de elección (AU)

We present two new cases of pelvic hydatid cysts, one with a clinical profile of local compression and the other one asymptomatic. The first case is a 75 year-old man who reported difficulty defecating and urinating. The ultrasound revealed a large cystic pelvic mass displacing the bladder and rectosigmoid region. Computed tomography also showed images compatible with hydatid disease and a hydatid liver cyst. The patient underwent a surgical procedure, and the pelvic cyst was partially excised. The other case is an asymptomatic 75 year-old man with pelvic hydatid disease that was discovered by chance while examining a prostatic adenoma. Because he is asymptomatic, we opted for observation. The anatomical pathology study confirmed the diagnosis in the first case and radiological findings confirmed the second. Both patients remain asymptomatic. Hydatid disease must be considered in the differential diagnosis for any cystic masses in the pelvic organs, especially in countries where the disease is endemic. Although no 100% specific serological test exists, there are some radiological procedures which can help us to confirm the disease. Surgery is the treatment of choice (AU)

Aneurisma de aorta abdominal infrarrenal en asociación con riñón en herradura: aportación de un caso / New case of an infrarenal abdominal aortic aneurysm associated with horseshoe kidney

Se analiza la relación entre enfermedad aórtica quirúrgica y riñón en herradura, y se comentan los problemas diagnósticos y las diferentes posibilidades terapéuticas. Paciente de 81 años con riñones en herradura que, durante el seguimiento de su enfermedad prostática, se descubre de forma casual por ecografía un aneurisma de aorta abdominal. Se realizó mediante abordaje retroperitoneal una resección del aneurisma y bypass aorto aórtico, sin complicaciones. A los 2 años del diagnóstico, el paciente continúa asintomático en cuanto a la alteración vascular. La coexistencia de riñón en herradura y afección aórtica que precise corrección quirúrgica ocurre con poca frecuencia, pero incrementa de forma significativa la complejidad técnica de la reconstrucción aórtica. Se realiza una revisión de la literatura (AU)

We review the association between surgically resolvable aortic disease and horseshoe kidney with a discussion of diagnostic problems and therapeutic options. Male patient 81 years of age with horseshoe kidney and an abdominal aortic aneurysm that was discovered by chance in an abdominal ultrasound during a check-up for his prostate condition. A retroperitoneal approach was used in order to resect the aneurysm and perform an aorto-aortic bypass with no complications occurring. Two years after the diagnosis, the patient is still asymptomatic from a vascular point of view. The co-presence of horseshoe kidney and aortic disease needing surgical correction is infrequent, but it significantly increases the technical complexity of aortic reconstruction. A literature review is included (AU)

[Does a pT0 cystectomy specimen imply being tumour-free in the long term?]. / ¿Implica el T0 en la pieza de cistectomía encontrarse libre de tumor a largo plazo?

INTRODUCTION AND OBJECTIVES: The aim of this study was to evaluate the progress of patients with a pT0 radical cystectomy specimen in order to know what factors are helpful in deciding when the bladder can be preserved. MATERIAL AND METHODS: We reviewed 153 cases of radical cystectomies performed due to bladder tumours without neoadjuvant therapy between 1995 and 2005 and with a minimum of three years of follow-up. Stage pT0 patients were selected. We considered age at time of diagnosis, sex, pathological stage and grade of the tumour at the time of transurethral resection (TUR), number of resections, surgical factors, tumour characteristics (multifocal, papillary or solid), progression-free survival, cancer-specific survival and cause of death. We ran a univariate analysis of the different factors studied along with disease progression. RESULTS: 12.8% of cystectomy specimens were pT0N0. Progression occurred in 35% between 6 months and 4 years after the cystectomy. Cancer-specific survival was 75%. Five patients died within an average of 18 months. The cause of death for all of them was tumour progression with distant metastasis. Statistical studies in the univariate analysis were only related to progression and the number of prior TURs, which is probably due to the number of cases, but the tumour multifocality, grade and stage were noteworthy. 15% of the pT0 patients had a papillary phenotype and 33% of them died. Of those with a non-papillary phenotype, 23.5% died. CONCLUSIONS: A stage pT0N0 cystectomy specimen does not define this surgery as curative, and these cases require the same follow-up as for the rest of the patients. It is of particular interest that out of all of our cases, there was no local recurrence, but there was distant metastasis. This leads us to believe that these patients could have benefitted from systemic chemotherapy with no need for radical surgery. In our study, the number of previous relapses was the only prognostic factor with statistical significance.

¿Implica el T0 en la pieza de cistectomía encontrarse libre de tumor a largo plazo? / Does a pT0 cystectomy specimen imply being tumour-free in the long term?

Introducción y objetivos: El objetivo de este estudio fue evaluar la evolución de los pacientes que presentaban un T0 en la pieza de cistectomía para conocer posibles factores que nos ayuden a decidir cuándo hacer preservación vesical. Material y métodos: Revisamos 153 cistectomías radicales realizadas por tumor vesical y sin tratamiento neoadyuvante en nuestro centro entre 1995 y 2005, con un seguimiento mínimo de 3 años. Seleccionamos los pacientes con pT0N0. Se tuvieron en cuenta la edad al diagnóstico, el sexo, el estadio y el grado patológico de la resección transuretral (RTU), número de resecciones, características del tumor (multifocalidad, papilar o sólido), tiempo libre de progresión, supervivencia libre de enfermedad y causa de muerte. Realizamos un análisis univariado de los diversos factores estudiados con la progresión de la enfermedad. Resultados: Un 12,8% de las piezas de cistectomías fueron T0N0. La progresión ocurrió en un 35% en un plazo de entre 6 meses y 4 años después de la cistectomía. La supervivencia cáncer específica fue del 75%; 5 pacientes murieron en una media de 18 meses. La causa de la muerte fue en todos ellos progresión tumoral con metástasis a distancia. Los estudios estadísticos en un análisis univariado sólo relacionaban con progresión, el número de RTU previas, probablemente debido al tamaño muestral, aunque la multifocalidad y el grado y el estadio tumoral resultaban destacables. Un 15% de los pacientes con pT0 tenían un fenotipo papilar, y de ellos un 33% murieron. Con fenotipo no papilar murieron un 23,5%. Conclusiones: Un pT0N0 en la pieza de cistectomía no define esta cirugía como curativa y nos exige un seguimiento del paciente similar al resto. Es de destacar que no hubo recurrencia local en nuestros casos, sino metástasis a distancia, lo que nos hace pensar que estos pacientes podían haberse beneficiado de un tratamiento con quimioterapia sistémica sin requerir cirugía radical. En nuestra serie, el número de recidivas previas fue el único factor pronóstico con significación estadística (AU)

Introduction and objectives: The aim of this study was to evaluate the progress of patients with a pT0 radical cystectomy specimen in order to know what factors are helpful in deciding when the bladder can be preserved. Material and methods: We reviewed 153 cases of radical cystectomies performed due to bladder tumours without neoadjuvant therapy between 1995 and 2005 and with aminimum of three years of follow-up. Stage pT0 patients were selected. We considered age at time of diagnosis, sex, pathological stage and grade of the tumour at the time of transurethral resection (TUR), number of resections, surgical factors, tumour characteristics (multifocal, papillary or solid), progression-free survival, cancer-specific survival and cause of death. We ran a univariate analysis of the different factors studied along with disease progression. Results: 12.8% of cystectomy specimens were pT0N0. Progression occurred in 35% between 6 months and 4 years after the cystectomy. Cancer-specific survival was 75%. Five patients died within an average of 18 months. The cause of death for all of them was tumour progression with distant metastasis. Statistical studies in the univariate analysis were only related to progression and the number of prior TURs, which is probably due to the number of cases, but the tumour multifocality, grade and stage were noteworthy. 15% of the pT0 patients had a papillary phenotype and 33% of them died. Of those with a non-papillary phenotype, 23.5% died. Conclusions: A stage pT0N0 cystectomy specimen does not define this surgery as curative, and these cases require the same follow-up as for the rest of the patients. It is of particular interest that out of all of our cases, there was no local recurrence, but there was distant metastasis. This leads us to believe that these patients could have benefitted from systemic chemotherapy with no need for radical surgery. In our study, the number of previous relapses was the only prognostic factor with statistical significance (AU)

Pelvic hydatid disease as an example of pelvic masses of uncertain aetiology.

We describe two new cases of pelvic hydatid cysts, one with a clinical profile of local compression and the other one asymptomatic. The first case is a 75 year-old man who reported difficulty in defecating and urinating. An ultrasound revealed a large pelvic cystic mass displacing the bladder and rectosigmoid region. Computed tomography showed images compatible with hydatid disease and a hydatid liver cyst. The patient underwent a surgical procedure, with the pelvic cyst being partially excised. The other case of pelvic hydatid disease was asymptomatic, and was discovered by chance while examining a 75 year-old man for a prostatic adenoma. Because he was asymptomatic, we opted for observation. The pathology confirmed the diagnosis in the first case and radiological findings confirmed the second. Both patients are now asymptomatic. Hydatid disease must be considered in the differential diagnosis of any cystic masses in the pelvic organs, especially in countries where the disease is endemic. Although there are no serological tests which are 100% specific, there are some radiological procedures which can help to confirm the disease. Surgery is the treatment of choice.

New case of an infrarenal abdominal aortic aneurysm associated with horseshoe kidney.

We review the association between surgically resolvable aortic disease and horseshoe kidney with a discussion of diagnostic problems and therapeutic options. Male patient 81 years of age with horseshoe kidney and an abdominal aortic aneurysm that was discovered by chance in an abdominal ultrasound during a check-up for his prostate condition. A retroperitoneal approach was used in order to resect the aneurysm and perform an aorto-aortic bypass with no complications occurring. Two years after the diagnosis, the patient is still asymptomatic from a vascular point of view. The co-presence of horseshoe kidney and aortic disease needing surgical correction is infrequent, but it significantly increases the technical complexity of aortic reconstruction. A literature review is included.