Angiomiolipoma renal y complejo esclerosis tuberosa: resultados a largo plazo en seguridad y eficacia de terapia con everolimus / Renal angiomyolipoma and tuberous sclerosis complex: long-term safety and efficacy outcomes of Everolimus therapy

Introducción: El angiomiolipoma renal (AMLr) es una manifestación frecuente del complejo de esclerosis tuberosa (CET), estableciéndose, recientemente, el tratamiento con everolimus, como opción terapeútica novedosa, alternativa y no invasiva; sin embargo, existen datos limitados en la vida real y a largo plazo, por ello, el análisis de nuestra experiencia, en materia de seguridad y eficacia, aporta un valor añadido.Material y métodosSe realiza un análisis descriptivo de nuestra experiencia en pacientes con AMLr bilaterales gigantes, en el contexto de CET, tratados con 10 mg por vía oral de everolimus diario, durante una mediana de 71,5 meses. Evaluamos los parámetros como: tasa y duración de la respuesta; reducción del volumen renal y las lesiones; prevención de complicaciones, toxicidad presentada y causa.ResultadosConfirmamos la efectividad del tratamiento en cuatro pacientes jóvenes, con AMLr renales bilaterales, múltiples, de 12 (5 a 19) cm de diámetro máximo como mediana, desde junio del 2013 hasta la actualidad, con una reducción continua del tamaño de las lesiones, descenso del 30% del volumen, en el 75% al sexto mes y del 50% en la mitad de los sujetos después dos años, permaneciendo aún en respuesta. No se presentaron complicaciones como sangrado o deterioro del filtrado glomerular a largo plazo, con un perfil de seguridad favorable, sin interrupciones y con efectos adversos no acumulativos leves a moderados, en su mayoría durante el primer año de tratamiento.ConclusiónEverolimus es una opción terapéutica segura y eficaz para el AMLr y para diversas manifestaciones del CET, que se reproduce en la vida real, con seis años de seguimiento. (AU)

Introduction: Renal angiomyolipoma is a frequent manifestation of Tuberous Sclerosis Complex (TSC), for which everolimus therapy has been recently established as a novel non-invasive therapeutic option. As there are limited real life and long-term data, the analysis of our experience provides added value in terms of safety and efficacy.Material and methodsDescriptive analysis of our experience in patients with giant bilateral renal angiomyolipomas, in the context of TSC, treated with 10 mg oral everolimus daily, during a median of 71.5 months. We evaluated the following parameters: response rate and duration, reduction of kidney size and lesions, prevention of complications and presentation of toxicity and its cause.ResultsWe confirm the effectiveness of treatment in 4 young patients, with multiple, bilateral angiomyolipomas of a median of 12 (5-19) cm maximum diameter, from June 2013 to date, after continuous reduction in lesion size, a decrease of 30% of the volume in 75% at six months and 50% in half of the subjects at two years, still showing drug response. Absence of complications such as bleeding or glomerular filtration rate decline in the long term, with a favorable safety profile, without interruptions and with mild-moderate, non-cumulative adverse effects, mostly within the first year of treatment.ConclusionEverolimus is a safe and effective therapeutic option for renal angiomyolipoma and various manifestations of TSC, which has been reproduced in real life with six years of follow-up. (AU)

Renal angiomyolipoma and tuberous sclerosis complex: long-term safety and efficacy outcomes of Everolimus therapy. / Angiomiolipoma renal y complejo esclerosis tuberosa: resultados a largo plazo en seguridad y eficacia de terapia con everolimus.

INTRODUCTION: Renal angiomyolipoma is a frequent manifestation of Tuberous Sclerosis Complex (TSC), for which everolimus therapy has been recently established as a novel non-invasive therapeutic option. As there are limited real life and long-term data, the analysis of our experience provides added value in terms of safety and efficacy. MATERIAL AND METHODS: Descriptive analysis of our experience in patients with giant bilateral renal angiomyolipomas, in the context of TSC, treated with 10 mg oral everolimus daily, during a median of 71.5 months. We evaluated the following parameters: response rate and duration, reduction of kidney size and lesions, prevention of complications and presentation of toxicity and its cause. RESULTS: We confirm the effectiveness of treatment in 4 young patients, with multiple, bilateral angiomyolipomas of a median of 12 (5-19) cm maximum diameter, from June 2013 to date, after continuous reduction in lesion size, a decrease of 30% of the volume in 75% at six months and 50% in half of the subjects at two years, still showing drug response. Absence of complications such as bleeding or glomerular filtration rate decline in the long term, with a favorable safety profile, without interruptions and with mild-moderate, non-cumulative adverse effects, mostly within the first year of treatment. CONCLUSION: Everolimus is a safe and effective therapeutic option for renal angiomyolipoma and various manifestations of TSC, which has been reproduced in real life with six years of follow-up.

Cistectomía radical, histerectomía con doble anexectomía y nefroureterectomía bilateral con extracción por vía transvaginal. Descripción y consideraciones específicas de la técnica quirúrgica / Radical cystectomy, hysterectomy with double adnexectomy and bilateral nephroureterectomy with transvaginal extraction

Objetivos: La aparición de carcinoma urotelial sincrónico en la vía urinaria superior e inferior es infrecuente, y lo es aún más la aparición de forma bilateral. El objetivo de este artículo es describir la técnica quirúrgica de exéresis completa del aparato urinario por vía laparoscópica y añadir diferentes variantes técnicas que permiten mejorar la hemodinámica del paciente durante la cirugía. Material y métodos: Presentamos la técnica de cistectomía con nefroureterectomía bilateral, histerectomía con doble anexectomía y linfadenectomía ilio-obturatriz bilateral por vía laparoscópica y extracción de piezas vía transvaginal en una paciente de 58 años con múltiples resecciones previas vesicales de carcinoma urotelial de alto grado, que en la actualidad presentaba recidiva vesical y tumoración ureteropiélica bilateral. La técnica consiste en primer lugar en la histerectomía y doble anexectomía junto con linfadenectomía y cistectomía, manteniendo la unión uretrovesical, uniones ureterovesicales y la unión útero-vaginal. Tras cambiar de posición a la paciente se realizan ambas nefroureterectomías y finalmente completamos la resección de los segmentos antes referidos para extraer las piezas por vía transvaginal. Resultados: El resultado histológico fue de carcinoma urotelial de alto grado que afecta a la vejiga y a ambas uniones ureteropiélicas, junto con carcinoma endometrial. Tras revisar la literatura hemos encontrado menos de 10 casos en los que se realice una exéresis completa del aparato urinario, y ninguna con la descripción técnica que presentamos en este artículo. En la mayoría de los casos descritos en la bibliografía se hace la cirugía en 2 tiempos y sin preservar la función renal hasta el final de exéresis completa. Conclusión: Esta técnica permite mantener la diuresis más tiempo durante la cirugía, y de ese modo facilitar la labor del anestesista y mejorar la dinámica circulatoria del paciente. Además, de este modo se previene cualquier tipo de manipulación de la vía urinaria evitando el paso de células tumorales a la cavidad peritoneal, puesto que se extrae de forma íntegra las piezas a través de la vagina

Objectives: The onset of synchronous urothelial carcinoma in the upper or lower urinary tract is uncommon. Even more uncommon is the onset the bilateral form. The aim of this article is to describe the surgical technique of complete laparoscopic exeresis of the urinary apparatus and to add several variants of the technique that improve the patient's hemodynamics during surgery. Material and methods: We present the technique of cystectomy with bilateral nephroureterectomy, hysterectomy with double adnexectomy and bilateral ilio-obturator lymphadenectomy by laparoscopy and transvaginal extraction of specimens from a 58-year-old patient with multiple prior vesical resections of high-grade urothelial carcinoma. The patient currently presents bladder recurrence and bilateral ureteropelvic tumor. The technique consists first of the hysterectomy and double adnexectomy along with the lymphadenectomy and cystectomy, maintaining the urethrovesical, ureterovesical and uterovaginal junctions. After changing the patient's position, both nephroureterectomies were performed. Lastly, we completed the resection of the previously mentioned segments to extract the specimens transvaginally. Results: The histological result was high-grade urothelial carcinoma that affected the bladder and both ureteropelvic junctions, along with endometrial carcinoma. After reviewing the literature, we found less than 10 cases in which complete exeresis of the urinary apparatus was performed and none with the technical description presented in this article. In most cases described in the literature, surgery was performed at 2 separate times and without preserving renal function until the end of the complete exeresis. Conclusion: This technique helps maintain diuresis for a longer time during surgery and thereby facilitates the work of the anesthesiologist and improves the patient's circulatory dynamics. Additionally, the technique prevents any type of handling of the urinary tract, thereby avoiding the passage of tumor cells to the peritoneal cavity, given that the specimens are extracted whole through the vagina

Experiencia inicial con acetato de abiraterona en pacientes con cáncer de próstata resistente a la castración / Initial experience with abiraterone acetate in patients with castration-resistant prostate cancer

Objetivo: Describir los resultados obtenidos de la experiencia en el tratamiento con acetato de abiraterona (AA) en 25 hombres con cáncer de próstata metastásico resistente a la castración (CPMRC). Realizamos el análisis comparativo de la eficacia y seguridad de este fármaco en relación con la literatura existente. Material y método: Estudio biinstitucional prospectivo de una cohorte de 25 pacientes consecutivos que reciben tratamiento con AA por CPMRC, con un seguimiento medio 7,9 (3-15) meses. Análisis de la seguridad y eficacia del tratamiento en relación con las características basales de los pacientes (edad, tratamientos previos, PSA basal, performance status, dolor, metástasis). Resultados: La supervivencia global es del 80% a los 13,6 meses de seguimiento (IC 95%: 11,8-15,4). La supervivencia libre de progresión clínico-radiológica de la serie es de 9,5 ± 1 meses (IC 95%: 7,7-11,3) y el de respuesta bioquímica de 6,8 ± 1 meses (IC 95%: 5-8,7). Solo el tratamiento previo con quimioterapia empeora significativamente el tiempo de respuesta a AA (supervivencia libre de progresión radiológica 6,4 meses [IC 95%: 4,2-8,6] y bioquímica de 4,3 meses [IC 95%: 2,6-6]). La incidencia de efectos adversos fue del 36%, todos grado 1-2/4, y en ningún caso requiere suspender o disminuir la dosis de AA. Conclusiones: El tratamiento con AA ha sido eficaz en nuestra serie, con una tolerabilidad considerablemente mayor a lo publicado en otros estudios

Objective: To describe the results obtained in 25 men 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. Materials 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, and 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 were of 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

Radical cystectomy, hysterectomy with double adnexectomy and bilateral nephroureterectomy with transvaginal extraction.

OBJECTIVES: The onset of synchronous urothelial carcinoma in the upper or lower urinary tract is uncommon. Even more uncommon is the onset the bilateral form. The aim of this article is to describe the surgical technique of complete laparoscopic exeresis of the urinary apparatus and to add several variants of the technique that improve the patient's hemodynamics during surgery. MATERIAL AND METHODS: We present the technique of cystectomy with bilateral nephroureterectomy, hysterectomy with double adnexectomy and bilateral ilio-obturator lymphadenectomy by laparoscopy and transvaginal extraction of specimens from a 58-year-old patient with multiple prior vesical resections of high-grade urothelial carcinoma. The patient currently presents bladder recurrence and bilateral ureteropelvic tumor. The technique consists first of the hysterectomy and double adnexectomy along with the lymphadenectomy and cystectomy, maintaining the urethrovesical, ureterovesical and uterovaginal junctions. After changing the patient's position, both nephroureterectomies were performed. Lastly, we completed the resection of the previously mentioned segments to extract the specimens transvaginally. RESULTS: The histological result was high-grade urothelial carcinoma that affected the bladder and both ureteropelvic junctions, along with endometrial carcinoma. After reviewing the literature, we found less than 10 cases in which complete exeresis of the urinary apparatus was performed and none with the technical description presented in this article. In most cases described in the literature, surgery was performed at 2 separate times and without preserving renal function until the end of the complete exeresis. CONCLUSION: This technique helps maintain diuresis for a longer time during surgery and thereby facilitates the work of the anesthesiologist and improves the patient's circulatory dynamics. Additionally, the technique prevents any type of handling of the urinary tract, thereby avoiding the passage of tumor cells to the peritoneal cavity, given that the specimens are extracted whole through the vagina.

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.

Bilateral primary renal lymphoma: case report and bibliographic review.

OBJECTIVE: To review the presentation, diagnosis and treatment of primary renal lymphoma through a new case report. METHODS: We report the case of a 73-year-old man who presented at A&E with constitutional symptoms and weight loss of 9 kilograms over 3 months RESULTS: Laboratory analysis showed impaired renal function, anemia and hypercalcemia. Imaging tests showed a large solid mass in the right perirenal area with infiltration of the parenchyma and Gerota's fascia surrounding the hilum of the kidney, as well as a solid mass in the inferior pole of the left kidney. Pathology showed the presence of lymphoid-like monomorphic cells. After establishing the diagnosis of bilateral primary renal lymphoma it was decided to start treatment with CHOP-Rituximab-type combination chemotherapy. CONCLUSIONS: Primary renal lymphoma is a rare entity and the diagnostic technique of choice is CT. Definitive diagnosis is confirmed on histology. In view of its aggressive nature and poor prognosis, it is important to make an early diagnosis in order to start treatment promptly. The treatment of choice is systemic chemotherapy using a CHOP regimen.

Linfoma renal primario bilateral: aportación de un nuevo caso y revisión de la literatura / Bilateral primary renal lymphoma: case report and bibliographic review

OBJETIVO: Revisar la forma de presentación, diagnóstico y tratamiento del linfoma renal primario mediante la presentación de un nuevo caso.MÉTODOS: Presentamos el caso de un de 73 años que acudió a Urgencias por síndrome constitucional y pérdida de peso de 9 kilos de 3 meses de evolución.RESULTADOS: En la analítica sanguínea se evidencia deterioro de la función renal, anemia e hipercalcemia. Las pruebas de imagen realizadas evidencian una gran masa solida perirrenal derecha con infiltración del parénquima incluida en la fascia de Gerota que engloba el hilio renal, además de una masa solida en el polo inferior del riñon izquierdo. El estudio anatomopatologico revela la presencia de células monomorfas de naturaleza linfoide. Tras establecer el diagnostico de linfoma renal primario bilateral se decide iniciar tratamiento con poliquimioterapia tipo CHOP-Rituximab.CONCLUSIONES: El linfoma renal primario es una entidad poco frecuente cuya técnica diagnostica de elección es el TC. El diagnostico definitivo se establece mediante estudio histológico. Dado su carácter agresivo y su mal pronóstico es importante realizar un diagnostico temprano para iniciar de forma precoz el tratamiento. La terapia de elección es la quimioterapia sistémica basada en el régimen CHOP(AU)

OBJECTIVE: To review the presentation, diagnosis and treatment of primary renal lymphoma through a new case report.METHODS: We report the case of a 73-year-old man who presented at A&E with constitutional symptoms and weight loss of 9 kilograms over 3 months.RESULTS: Laboratory analysis showed impaired renal function, anemia and hypercalcemia. Imaging tests showed a large solid mass in the right perirenal area with infiltration of the parenchyma and Gerota`s fascia surrounding the hilum of the kidney, as well as a solid mass in the inferior pole of the left kidney. Pathology showed the presence of lymphoid-like monomorphic cells. After establishing the diagnosis of bilateral primary renal lymphoma it was decided to start treatment with CHOP-Rituximab-type combination chemotherapy. CONCLUSIONS: Primary renal lymphoma is a rare entity and the diagnostic technique of choice is CT. Definitive diagnosis is confirmed on histology. In view of its aggressive nature and poor prognosis, it is important to make an early diagnosis in order to start treatment promptly. The treatment of choice is systemic chemotherapy using a CHOP regimen(AU)

[Leiomyosarcoma of the spermatic cord: report of two cases]. / Leiomiosarcoma del cordón espermático: aportación de dos casos.

Radical surgery is the only feasible and successful treatment for paratesticular sarcomas, with the exception of rabdomyosarcoma. The inguinal approach is the ideal and obligatory one, including excision of the spermatic cord and adjacent testicle. Long-term periodic follow-up visits are mandatory because relapses may ocurre even long time after diagnosis: In the case of relapse, surgery is again the only tool we have to control this type of tumor. We present two cases of paratesticular leiomyosarcoma, a tumor un common.

Leiomiosarcoma del cordón espermático: aportación de dos casos / Leiomyosarcoma of the spermatic cord: report of two cases

En los sarcomas paratesticulares, salvo en el rabdomiosarcoma, el único tratamiento factible y resolutivo es el quirúrgico radical. La vía obligatoria e ideal será la inguinotomía, con exéresis del cordón funicular y teste adyacente. Exige controles periódicos a largo plazo, dada las recidivas que pueden ocurrir incluso mucho tiempo después del diagnóstico. Ante una eventual recidiva la cirugía volverá a ser el único arma a nuestro alcance para el control de este tipo tumoral. Presentamos 2 casos de leiomiosarcoma paratesticular, un tumor de escasa frecuencia

Radical surgery is the only feasible and successful treatment for paratesticular sarcomas, with the exception of rabdomyosarcoma. The inguinal approach is the ideal and obligatory one, including excision of the spermatic cord and adjacent testicle. Long-term periodic follow-up visits are mandatory because relapses may ocurre even long time after diagnosis: In the case of relapse, surgery is again the only tool we have to control this type of tumor. We present two cases of paratesticular leiomyosarcoma, a tumor un common

[Bilateral and synchronic testicular neoplasia. A report of a new case]. / Neoplasia testicular bilateral sincrónica. Presentación de un nuevo caso.

Bilateral and synchronic testicular tumor is an unfrequent fact (0,17% of germinative tumors of testicle), being most cases seminomas. We present the case of a male, 25-year old patient underwent a bilateral radical orchiectomy for bilateral and synchronic testicular tumor. The result of anatomopathological examination revealed bilateral seminoma (pT2 in both testes). Patient received four courses of adjuvant chemotherapy (etoposide and cisplatin) for metastases (N2, M1). The patient is without evidence of disease two years after orchiectomy.

Neoplasia testicular bilateral sincrónica. Presentación de un nuevo caso / Bilateral and synchronic testicular neoplasia. A report of a new case

El tumor testicular bilateral y sincrónico es un hecho infrecuente (0,17% de los tumores germinales de testículo), siendo la mayoría de los casos seminomas. Nosotros presentamos el caso de un varón de 25 años de edad sometido a orquiectomía radical bilateral por tumor testicular bilateral sincrónico. El resultado del examen anatomopatológico reveló seminoma bilateral (pT2 en ambos testes). El paciente recibió 4 ciclos de quimioterapia (etopósido y cisplatino) adyuvante por enfermedad metastásica (N2, M1). 2 años después de la orquiectomía, el paciente está sin evidencia de enfermedad

Bilateral and synchronic testicular tumor is an unfrequent fact (0,17% of germinative tumors of testicle), being most cases seminomas. We present the case of a male, 25-year old patient underwent a bilateral radical orchiectomy for bilateral and synchronic testicular tumor. The result of anatomopathological examination revealed bilateral seminoma (pT2 in both testes). Patient received four courses of adjuvant chemotherapy (etoposide and cisplatin) for metastases (N2, M1). The patient is without evidence of disease two years after orchiectomy

[Mucinous adenocarcinoma of the urachus and peritoneal pseudomyxoma]. / Adenocarcinoma mucinoso de uraco y pseudomixoma peritoneal.

The adenocarcinoma of the urachus is very rare tumor, with an incidence of 1/5.000.000 inhabitants, represents less than 0.001 of all types of bladder cancer. Peritoneal pseudomixoma is a rare neoplasm characterized by mucinous acites that involvement the peritoneal surface and omentum. Usually is associated with benign o malignant mucinous tumor of the appendix or ovary. In this paper, we present a case of peritoneal pseudomixoma caused by a mucinous adenocarcinoma of the urachus.

Adenocarcinoma Mucinoso de Uraco y Pseudomixoma Peritoneal / AB muncinous adenocarcinoma of the urachus and peritoneal pseudomyxoma

El adenocarcinoma de uraco es un tumor extremadamente raro, con una incidencia de 1/5.000.000 de habitantes, lo que representa menos del 0,001 de todos los tumores de vejiga. El pseudomixoma peritoneal es una neoplasia rara caracterizada por ascitis mucinosa que envuelve la superficie peritoneal y el omento. Usualmente está asociada con tumores mucinosos benignos o malignos del apéndice u ovario. En este trabajo, presentamos un caso de pseudomixoma peritoneal causado por un adenocarcinoma mucinoso de uraco

The adenocarcinoma of the urachus is very rare tumor, with an incidence of 1/5.000.000 inhabitants, represents less than 0,001 of all types of bladder cancer. Peritoneal pseudomixoma is a rare neoplasm characterized by mucinous acites that involvement the peritoneal surface and omentum. Usually is associated with benign o malignant mucinous tumor of the appendix or ovary. In this paper, we present a case of peritoneal pseudomixoma caused by a mucinous adenocarcinoma of the urachus

Cáncer de pene. Una revisión de 18 casos / Cancer of the penis. A review of 18 cases

INTRODUCCIÓN: El carcinoma escamoso de pene es el tumor de pene más frecuente. Las metástasis ganglionares son relativamente frecuentes, pero la diseminación a distancia es muy rara. MATERIAL Y MÉTODOS: Entre 1990 y el 2002 fueron diagnosticados y tratados 18 casos de carcinoma de pene. El seguimiento mínimo fue de 2 años de evolución (de 2 a 11 años, con una media de 49 meses).El tratamiento de la lesión primaria, habitualmente por medio de la amputación parcial de pene, nos permite conocer el estadio patológico y el grado de diferenciación histológico, lo cual orientó primordialmente nuestra actitud frente a los ganglios linfáticos regionales. RESULTADOS: Las adenopatías inguinales palpables persistieron tras antibioterapia en 6 de 7 pacientes. Se realizaron 4 linfadenectomías inguinales precoces. Las complicaciones post-operatorias se presentaron en los 4 casos, siendo el linfedema la más frecuente (100 por ciento). CONCLUSIONES: La categoría del T y el grado histológico de la lesión primaria al momento de decidir la conducta en el manejo de los ganglios, evitará linfadenectomías innecesarias y por otro lado tratará radical y oportunamente aquellos que presenten alto riesgo de diseminación ganglionar (AU)

INTRODUCTION: Squamous cell carcinoma is the most common tumor of the penis. Nodal metastases are relatively common, but distant disemination is very rare. MATERIAL AND METHODS: From 1990 to 2002, we diagnosed and treated 18 cases of carcinoma of the penis. The minimum follow-up was 2 years (range 2-11 years; mean 49 months). Treatment of the primary lesion is usually by partial amputation of the penis, which enables us to determine the pathological stage and the histological grade of the tumor and, consequently, our approach to the reguional lymph nodes. RESULTS: Palpable inguinal nodes after antibiotherapy remained in six out of seven patients. Inguinal lymphadenectomy was performed early in 4 cases. Postoperative complications were present in the 4 cases, lymphedema being the most frequent one (100%). CONCLUSIONS: The T and the histological grade of the primary lesion must be considered when deciding the approach in the management of the lymph nodes as unnecesary lymphadenectomy can be avoided and those at high risk of lymph node invasion can be treated radically and timely (AU)

[Adrenal ganglioneuroma. Report of a new case]. / Ganglioneuroma suprarrenal. Aportación de un nuevo caso.

Ganglioneuroma is a benign neoplasm arising from neural crest tissue and is composed of mature ganglion cells and Schwann's cells. Most ganglioneuromas arise in the posterior mediastinum followed by the retroperitoneum. Only a small proportion of ganglioneuromas are adrenal in origin and occur most commonly in children and young adults. Characteristically, ganglioneuromas do not secrete excess catecholamines or steroid hormones, and they are usually clinically silent lesions incidentally detected in imaging studies for unrelated reasons. Because it is an uncommon lesion, adrenal ganglioneuromas is not included in the differential diagnosis of adrenal incidentalomas in adults. We presents a new case of a 6.5 cm adrenal ganglioneuroma incidentally diagnosed in a 50-year old male patient. The exeresis of the adrenal mass and pathohistological study confirmed the diagnosis.

Ganglioneuroma suprarrenal. Aportación de un nuevo caso / Adrenal ganglioneuroma. To report of a new case

El ganglioneuroma es una neoplasia benigna derivada de la cresta neural, compuesta de células ganglionares maduras y células de Schwann. La mayoría se localizan en el mediastino posterior, seguido del retroperitoneo. Sólo una pequeña proporción de ganglioneuromas se originan en la médula suprarrenal, siendo más frecuentes en niños y adultos jóvenes. Característicamente, los ganglioneuromas no secretan catecolaminas ni hormonas esteroideas, por lo que suelen ser lesiones clínicamente silentes que son detectadas incidentalmente en estudios de imagen realizados por otros motivos no relacionados. Por ser lesiones infrecuentes, los ganglioneuromas no suelen ser incluidos en el diagnóstico diferencial de los incidentalomas suprarrenales, particularmente en adultos. Presentamos un nuevo caso de ganglioneuroma suprarrenal de 6,5 cm, diagnosticado incidentalmente en un paciente de 50 años de edad. La exéresis de dicha masa y su posterior estudio histopatológico confirmaron el diagnóstico (AU)

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[Penile cancer. Review of 18 cases]. / Cáncer de pene. Una revisión de 18 casos.

INTRODUCTION: Squamous cell carcinoma is the most common tumor of the penis. Nodal metastases are relatively common, but distant disemmination is very rare. MATERIAL AND METHODS: From 1990 to 2002, we diagnosed and treated 18 cases of carcinoma of the penis. The minimum follow-up was 2 years (range 2-11 years; mean 49 months). Treatment of the primary lesion is usually by partial amputation of the penis, which enables us to determine the pathological stage and the histological grade of the tumor and, consequently, our approach to the regional lymph nodes. RESULTS: Palpable inguinal nodes after antibiotherapy remained in six out of seven patients. Inguinal lymphadenectomy was performed early in 4 cases. Postoperative complications were present in the 4 cases, lymphedema being the most frequent one (100%). CONCLUSIONS: The T and the histological grade of the primary lesion must be considered when deciding the approach in the management of the lymph nodes as unneccesary lymphadenectomy can be avoided and those at high risk of lymph node invasion can be treated radically and timely.

[Lumbar eventration as complication of the lumbotomy in the flank: review of our series]. / La eventración lumbar como complicación de la lumbotomía por el flanco: revisión de nuestra serie.

OBJECTIVES: To study the prevalence and risk factors of the lumbar eventration after lumbotomy in the flank. MATERIAL AND METHODS: Survey of 230 patients that underwent lumbotomy in the flank, with a least followup of two years. Statistical study: contingency 2 x 2 tables (Pearson's chi 2 or Fisher exact test) to compare qualitative variables, Student's test to compare quantitative variables, Kaplan-Meier test and comparison of Log-rank curves. For the study of clinical variables with more influence in postoperative lumbar eventration, a logistic regression model was used. RESULTS: The prevalence of postoperative lumbar eventration was 31.3%. Clinical variables more influence for postoperative lumbar eventration are: age, deficit of proteins, wound infection and haematoma of the abdominal wall. CONCLUSIONS: Eventration is one the most frequent complications in urologic surgery and is of primary importance due to its laboral, economic and social implications.

La eventración lumbar como complicación de la lumbotomía por el flanco: revisión de nuestra serie / Lumbar eventration as complication of the lumbotomy in the flank. Review of our series

OBJETIVOS: Estudiar la prevalencia y los factores de riesgo de la eventración lumbar tras lumbotomía por el flanco. MATERIAL Y MÉTODOS: Estudio de 230 pacientes sometidos a lumbotomía por el flanco, con un seguimiento mínimo de 2 años. Estudio estadístico: para comparar variables cualitativas: tablas de contingencia 2 x 2 (chi2 de Pearson o un exacto de Fisher), t de Student para comparar variables cuantitativas, test de Kaplan-Meier y para la comparación de curvas Log-rank. Para el estudio de las variables clínicas más influyentes en la eventración lumbar post-operatoria, un modelo de regresión logística. RESULTADOS: La prevalencia de eventración lumbar post-operatoria fue del 31,3 per cent. Las variables clínicas más influyentes para la eventración lumbar post-operatoria son: edad, hipoproteinemia, infección de la herida y hematoma de la pared abdominal. CONCLUSIONES: La eventración es una de las complicaciones más frecuentes de la cirugía urológica y tiene gran importancia debido a las implicaciones laborales, económicas y sociales que conlleva. La mejor forma de tratarla es prevenirla (AU)