[Genitourinary malacoplakia]. / Malacoplaquia genitourinaria.

Malacoplakia is a chronic inflammatory disease the etiology of which remains obscure. It has a very low incidence and affects primarily the genitourinary tract, although it has been described in some other organs. This paper presents a historic insight of the clinical cases diagnosed in this centre, and includes a review and update of several issues related to this entity such as pathogenesis, pathological anatomy and treatment. Also, the peculiarities related to the involvement of each separate organ with regard to diagnosis, prognosis and treatment are described.

[Clinico-pathologic study of renal cell carcinoma]. / Estudio clínico-patológico del carcinoma de células renales.

Renal cell carcinoma (RCC) is an uncommon tumour with high mortality mainly due to late diagnosis. The various morphological variables and the clinico-pathological stage, however, induce highly different evolutions. Awareness of these characteristics would be a significant part of deciding the most appropriate therapy for each case. The pathological anatomy of 130 renal cell carcinomas obtained through nephrectomy was reviewed. A follow-up of at least 5 years was done in 121 patients. Also, a survival study related to the various clinical and pathological parameters was carried out. A significantly lower survival rate was observed for solid tumours with spindle or giant cells and nuclear degrees superior to 2, over 10 mitosis in 10 fields and staging higher than II. A significant correlation was also found between number of mitosis and staging, presence of metastatic disease, survival interval, degree of tumoral necrosis, histological type, cell type and nuclear grade. Our results indicate that staging, histological type, cell type, microscopic vascular infiltration, nuclear grade and number of mitosis can be highly predictive of the evolution and prognosis of RCC patients.

Pathology of the kidney in "toxic oil epidemic syndrome".

In May 1981, a massive intoxication of people who had ingested adulterated cooking oil took place in Madrid and nearby provinces. Although the patients presented, in the first phase of the disease, with acute respiratory illness, later on thromboembolic complications, severe neuromuscular involvement, and scleroderma-like cutaneous lesions appeared. Kidneys were apparently spared; however, 4 out of 842 admitted patients developed glomerulonephritis; kidney biopsies revealed glomerular, vascular, tubular, and interstitial changes. Cases 1 and 3 had diffuse proliferative endocapillary glomerulonephritis; case 2 had diffuse membranoproliferative glomerulonephritis; and case 4 had diffuse extracapillary glomerulonephritis. Three cases had vascular lesions characterized by degenerative and proliferative endothelial changes, intimal foamy macrophages, and partial or complete obliteration of the vascular lumen by concentric myxoid fibrosis. There were signs of necrosis of tubular epithelium along with edema and lymphocytic and eosinophilic interstitial infiltration. Two out of 22 autopsies had segmentary glomerulonephritis, and 17 out of 22 autopsies showed renal vascular lesions.

[Familial and hereditary mesangial glomerulonephritis with IgA deposits (author's transl)]. / Glomerulonefritis mesangial con depósitos de IgA, familiar y hereditaria.

Idiopathic mesangial glomerulonephritis with IgA deposits was observed in two relatives, father and son, in a family of 5 members. In the father the disease started at age 43 with relapsing macroscopic hematuria, proteinuria, renal failure and hypertension, with a progressive course in the ensuing four years. The affected son, the oldest of three brothers, developed relapsing macroscopic hematuria at age 16; two years later renal function was normal and there was no hypertension, but microhematuria persisted without proteinuria. The mother and the other two brothers had no clinical or biological signs of renal disease. Serum immunoglobulins (IgG, IgA, and IgM) and complement (C3, C4, C3 proactivator) were normal in the patients and their relatives. Histocompatibility typing demonstrated the presence of HLA-Bw35 in the father and the two unaffected sons, being negative in the mother and the affected son. The analysis of HLA-Bw35 in 23 patients with IgA mesangial glomerulonephritis gave positive results in 30% of them, while the control group had a positivity of 15% (p non significant with the X2 test). The present observations suggest that IgA mesangial glomerulonephritis is a potentially familial and hereditary renal disease. HLA-Bw35 antigen appears not to be a genetic marker of the disease in our geographical area.