[Therapeutic approach in adrenal melanoma. Review of the literature]. / Actitud terapéutica en el melanoma suprarrenal. Revisión de la literatura.

OBJECTIVE: To review the treatment strategies for adrenal melanoma and to emphasize the role of curative surgical resection and adjuvant treatment in selected patients with melanoma metastatic to the adrenal gland versus chemotherapy alone in the treatment of patients with advanced malignant melanoma. METHODS: A case of adrenal gland metastasis of a cutaneous melanoma (Clark IV, Breslow 5 mm.) treated by excision one year before that was referred to the Urology Department for Wünderlich syndrome is presented. RESULTS: The analyzed series of programmed adrenalectomy for adrenal metastases from melanoma describe survivals of 26 (3), 36 (9), 59 (3) and 72 (5) months. In our case the patient died at home one month later due to stroke, although concomitant brain metastasis is suspected. Autopsy was not performed. CONCLUSIONS: In the differential diagnosis of an incidentaloma, metastatic disease is likely in a patient with a history of malignant disease. The frequency of malignant melanoma among metastatic adrenal disease varies between 1% and 8.6%; the majority are asymptomatic and incidental findings. We believe that in selected patients with advanced malignant melanoma, with no major coexisting morbidity factors who have isolated melanoma metastatic to the adrenal gland or with limited extra-adrenal sites of disease, curative surgical resection and adjuvant treatment may improve their survival. It must be emphasized that all patients should be followed after surgical resection of the primary tumor because it will facilitate staging of the disease and avoid emergency situations of ruptured friable metastases that make complete resection difficult.

[Differential diagnosis of epididymal leiomyoma. Report of a new case]. / Diagnósticos diferenciales del leiomioma de epidídimo. Aportación de un nuevo caso.

OBJECTIVE: A case of epididymal leiomyoma is presented. This lesion is uncommon and sometimes misdiagnosed. The literature is briefly reviewed. METHODS/RESULTS: A 29-year-old patient presented with a tumor in the tail of the right epididymis that was initially diagnosed as scrotal hematoma or complex cyst in the tail of the epididymis. RESULTS/CONCLUSIONS: Ultrasound has an important role in distinguishing testicular from epididymal tumors. However, if the diagnosis is unclear, surgical resection and subsequent anatomopathological analysis must be performed.

[Primary neuroectodermal tumor (PNET) of the kidney: 26 cases. Current status of its diagnosis and treatment]. / Tumor neuroectodérmico primitivo renal (PNET): 26 casos. Estado actual de su diagnóstico y tratamiento.

OBJECTIVE: To report a case of primitive neuroectodermal tumor (PNET) of the kidney and review the literature and the 25 cases previously reported as PNET. METHODS: A 39-year-old man who consulted for nephric colic is described. Ultrasound evaluation disclosed a mass arising from the left kidney. The clinical, radiological and pathologic features, treatment and differential diagnosis of small cell tumors are discussed, as well as the important role of immunohistochemical techniques (positive staining with O13 or 12E7 antibodies) and cytogenetic analysis [a characteristic chromosomal translocation t(11;22) (q24;q12) or variant translocation, such as t(21;22) (q22;q12), may be detected by fluorescence in situ hybridization (FISH) or polymerase chain reaction-reverse transcriptase (PCR-RT)]. RESULTS: Survival of our patient was 20 months. Only three of the 25 previously reported cases had a longer survival: 60, 48 and 24 months. Mean survival was 10 months. 95.24% of the cases were positive for NSE. Immunostaining (CD99) was performed in 16 patients and was found to be positive in all cases. Cytogenetic and molecular analyses were performed in 11 cases; PCR-RT was negative in two, as well as in the case described herein. CONCLUSIONS: PNET is a highly aggressive neoplasm that tends to recur locally and to metastasize. Despite the poor response to standard therapy combining surgical resection, postoperative irradiation and chemotherapy, the results might change due to current research on genetic therapy based on creating antisense oligonucleotides against the EWS-FLI 1 fusion gene.

[Stromal tumor of the rectum and leiomyosarcoma of the prostate as a cause of urinary syndrome attributable to BPH]. / Tumor estromal de recto y leiomiosarcoma de próstata como causa de síndrome miccional atribuible a HBP.

OBJECTIVE: To discuss the classifications of patients with lower urinary tract symptoms ascribed to BPH, in order to define the indication for treatment for patients with similar features but of a different etiology. The literature is also reviewed. METHODS/RESULTS: Two patients, aged 62 and 63 years, diagnosed as having BPH were found to have a gastrointestinal stromal tumor (GIST) and a leiomyosarcoma of the prostate, respectively. The first patient had undergone retropubic resection. Frozen section analysis revealed a GIST. The second patient had undergone TURP twice. A perineal biopsy at the last medical examination showed a leiomyosarcoma of the prostate. This patient finally underwent pelvic tumorectomy. The international classification of BPH is discussed: PQSF (P: prostatic weight determined by transrectal US or DRE; Q: quality of life assessment; S: international prostate symptom score (IPSS); F: maximum urinary flow rate by uroflowmetry--Qmax). CONCLUSIONS: The classifications are practical, but should be improved. In our view, details useful in orienting the diagnosis could be lost by oversimplification.

[Surgical correction of congenital penile curvatures using the Nesbit technique. Apropos of 24 cases]. / Corrección quirúrgica de curvaduras congénitas de pene, según técnica de Nesbit. A propósito de 24 casos.

We present our experience of 24 cases with congenital penile deviation without hypospadias. Treatment was by surgical correction of the curvature using the Nesbit technique. We briefly describe the diagnostic methods and the parameters utilized for surgical planning and evaluation of the results of surgery. This simple procedure achieved good results in all of our cases.

[Polycythemia as the first and only manifestation of renal adenocarcinoma]. / Policitemía como primera y única manifestación de adenocarcinoma renal.

We report on a 40-year-old patient with adenocarcinoma of the right kidney whose first and only manifestation was the erythrocytosis that had been detected on routine analytical work up. The diagnostic methods (US, IVP, CT, aspiration biopsy cytology and renal arteriography) and treatment (right nephrectomy via extended thoracophrenolaparotomy incision at the level of the ninth rib) are briefly described. The polycythemia remitted following nephrectomy. The etiopathogenesis and hypotheses that have been put forward relative to polycythemia in renal adenocarcinoma are briefly discussed. Renal tumor, particularly renal adenocarcinoma, should be suspected in the presence of polycythemia of unknown origin. Persistent or recurrent polycythemia should prompt us to suspect incomplete tumor excision or metastasis. Surgical risks (embolism, hemorrhage, etc.) may be reduced if hematocrit levels are brought down to within normal levels by bleeding.

[Kidney injuries: a review of 149 cases. A change in the diagnostic and therapeutic approaches]. / Traumatismos renales: revisión de 149 casos. Cambio en la actitud diagnóstica y terapéutica.

We reviewed 149 cases of renal trauma that were seen at the Urology Service of Hospital de Navarra from January, 1975 to December, 1989. The severity of the renal injury, type (open or closed), the presence of previous lesions, renal changes, and the diagnostic and therapeutic approaches were analyzed. The follow-up urologic and nephrologic controls are briefly described. Most of the cases with important renal injury have been followed for one to five years. We observed as increased incidence of renal injuries from road traffic accidents in younger patients with a prevalence in the male. Treatment is more conservative and less nephrectomies have been performed. CT, US, renal arteriography and isotope studies have become widely available. The endourological and transcutaneous techniques have been widely used in the treatment of these patients.

[Surgical adrenal gland pathology. Urologist's pathology]. / Patología quirúrgica suprarrenal. Patología propia del urólogo.

We reviewed 6 cases of unilateral adrenal tumor that had been treated during a 5-year period. The Turner-Warwick modified lateral approach was performed in all 6 cases. In our view, surgical treatment of unilateral adrenal tumors should be performed by the urologist. The high lumbar approach appears to be the most appropriate for unilateral adrenal tumor masses not larger than 6 cm. The surgical anatomy of the adrenal gland is briefly described.

[Image diagnosis in primary retroperitoneal tumors]. / Diagnóstico por la imagen en los tumores retroperitoneales primitivos.

We present our experience in the diagnosis-through-image with 25 primitive retroperitoneal tumours over a period of 17 years. The histological type most frequently found was that derived from mesodermal tissue (64%). Abdominal pain and mass were the typical symptoms of the presentation. The paper analyzes the radiological studies used (except NMR) with regard to the diagnostic value they have in this sort of pathology. UIV continues to be the initial examination when a retroperitoneal tumour is suspected, obtaining a diagnostic orientation of 70%. The remaining diagnostic techniques (except arteriography and CAT) should be used as a diagnostic supplement or to assess the disease progression, unless the initial clinical symptoms make their use advisable, since the diagnostic orientation provided is usually below 50%. The use of CAT together with monitored aspiratory puncture provided a diagnostic reliability over 90%, so we conclude this should be the examination technique of choice when retroperitoneal tumour is suspected.

[Diagnostic value of computerized axial tomography in urology]. / Valor diagnóstico de la tomografía axial computorizada en urología.

A study is made of the diagnostic value of computerized axial tomographies in 57 patients suffering from urogenital pathology. Only three mistakes which may be attributed to a wrong assessment of the sections support its high degree of reliability. The CAT does not replace the intravenous urography. With regard to other more aggressive means (angiography, endoscopy) or less determining ones (isotopes, ultrasounds), it establishes some stricter indications for the same. The main indications of the CAT in Urology are the study of non-cystic, kidney masses as well as non-functioning kidneys, retroperitoneum and suprarenal glands and finally the establishment of the tumoural stage of prostate, bladder and testicle neoformations. The future of the CAT offers great possibilities as certain technical problems are solved and at the same time as greater experience is gained and its price reduced, all of which constitute factors which currently limit its clinical use.