[Mucinous adenocarcinoma of the prostate]. / Adenocarcinoma mucinoso de próstata.

OBJECTIVE: To describe a case of mucinous adenocarcinoma of the prostate. METHODS: A 77-year-old patient presented with urinary complaints. Patient evaluation showed an enlarged prostate and increased PSA levels. RESULTS: A prostate biopsy showed a glandular neoplasm with extensive mucinous differentiation and abundant lacunae of PAS positive mucus (mucinous adenocarcinoma). The patient remains well one year after the diagnosis. CONCLUSIONS: Mucinous adenocarcinoma of the prostate is a rare variant that should be recognized and does not necessarily imply a worse prognosis than other carcinomas of the prostate.

[Bladder adenocarcinoma with glandular cystitis areas]. / Adenocarcinoma vesical con áreas de cistitis glandular.

OBJECTIVE: To describe a case of adenocarcinoma of the urinary bladder. METHODS: A 63-year-old patient consulted for gross hematuria. Ultrasound evaluation showed a bladder neoplasm and CT demonstrated extensive infiltration of adjacent structures. RESULTS: Histological analysis of the TUR specimen confirmed a muscle infiltrating glandular neoplasm (adenocarcinoma) with diffuse areas of cystitis glandularis. Patient evolution has been poor and he is now in the end stage of the disease. CONCLUSIONS: The morphology is not unlike that of colorectal carcinoma, which should be distinguished. The association of areas of cystitis glandularis indicates a possible relationship.

Perforación vesical extraperitoneal espontánea por carcinoma vesical / Spontaneous extraperitoneal vesical perforation due to bladder cancer

Aportamos un caso de perforación vesical extraperitoneal espontánea, debida a la presencia de un carcinoma vesical de naturaleza urotelial (AU)

Pielonefritis xantogranulomatosa con fístula en región glútea / Xantogranulomatous pyelonephritis with neprocutaneus fistula at the buttock

No disponible

[Differential diagnosis of intrascrotal calcification: lithiasis attached to hydrocele wall]. / Diagnóstico diferencial de calcificación intraescrotal: litiasis adherida a pared de hidrocele.

OBJECTIVE: To report a case of scrotal calculus in a hydrocele, attached to the parietal portion of the tunica vaginalis, complicating the differential diagnosis. METHODS: A 54-year-old patient with a clinical diagnosis of hydrocele is described. Ultrasound confirmed the diagnosis and demonstrated a calcified structure in the hydrocele fluid, attached to the parietal portion of the tunica vaginalis. A calculus of 1.7 cm diameter was found during the surgical procedure. CONCLUSION: The presence of calculus in a hydrocele does not change the prognosis or treatment of this condition, although some doubts may arise during sonographic assessment if it is attached to the parietal portion of the tunica vaginalis.

[Pigmented renal carcinoma, rich in hemosiderin]. / Carcinoma renal pigmentado, rico en hemosiderina.

OBJECTIVE: To report a case of hemosiderin-rich, pigmented renal cell carcinoma. METHODS: A 70-year-old patient referred several episodes of gross hematuria during the last few weeks, without any other symptoms. CT demonstrated a renal mass compatible with carcinoma. A right renal nephrectomy was performed. RESULTS: Anatomopathological analysis revealed a hemosiderin-rich, pigmented, papillary renal cell carcinoma localized to the renal capsule that stained blue with the iron staining method. The postoperative period was unremarkable and the patient is asymptomatic one year postoperatively. CONCLUSION: Papillary renal cell carcinoma can present as a pigmented lesion due to the accumulation of iron in the cytoplasm. This peculiar form must be distinguished from neuromelanin-pigmented lesions.

[Renal carcinoma with intranuclear inclusions associated with colon carcinoma]. / Carcinoma renal con inclusiones intranucleares asociado a carcinoma de colon.

OBJECTIVE: To report a case of renal cell carcinoma associated with carcinoma of the colon. METHODS: A right renal mass was detected during US control evaluation of a patient that had undergone surgery for rectosigmoid carcinoma 4 months earlier. A previous abdominal CT scan revealed a renal mass with characteristics of malignancy. Fine-needle aspiration biopsy showed clear cell renal carcinoma. This case was considered as two different and synchronous primaries, and the patient was submitted to surgery. RESULTS: Intestinal adhesions secondary to radiotherapy were found intraoperatively, but there was no evidence of local intestinal recurrence, and therefore nephrectomy was performed. The histopathological study demonstrated clear cell renal carcinoma with intranuclear inclusions. CONCLUSIONS: Although the patient may have a previous history of carcinoma at another site, the finding of a renal mass excludes synchronous tumors and nephrectomy should be the treatment of choice. The finding of clear cells in the cytological study supports the interpretation that these lesions were different primaries. Renal carcinoma should be included among the neoplasms with intranuclear inclusions.

[Bladder metastasis of signet-ring cell adenocarcinoma from the stomach]. / Metástasis vesical de adenocarcinoma de células en anillo de sello de origen gástrico.

OBJECTIVE: To describe an additional case of metastatic bladder tumor from gastric signet-ring cell adenocarcinoma. METHODS/RESULTS: Local recurrence was demonstrated by gastrointestinal endoscopy and biopsy in a 52-year-old female who underwent total gastrectomy for signet-ring cell gastric adenocarcinoma two years earlier. A CT scan showed bilateral hydronephrosis and diffuse thickening of the bladder wall. Bladder biopsy demonstrated signet-ring cell adenocarcinoma. Palliative treatment with ureteral catheterization was instituted. CONCLUSIONS: Signet-ring cell adenocarcinoma of the bladder is usually a primary tumor. Metastatic signet-ring cell adenocarcinoma to the urinary bladder is uncommon.

[Spontaneous extraperitoneal bladder perforation caused by bladder carcinoma]. / Perforación vesical extraperitoneal espontánea por carcinoma vesical.

We show a case of spontaneous extraperitoneal vesical perforation due to presence of a bladder cancer with urotelial origin.

[Rapidly metastasizing renal carcinoma with intense expression of p53 and P-glycoprotein]. / Carcinoma renal rápidamente metastatizante con intensa expresión de p53 y glicoproteína P.

OBJECTIVE: A case of rapidly metastasizing renal carcinoma is presented. METHODS: A 62-year-old man complained of fever for the past 6 weeks and weight loss. An abdominal CT disclosed two cystic hepatic lesions compatible with hydatid cysts and a mass in the upper pole of the left kidney suggestive of a carcinoma. The patient underwent resection of the kidney. RESULTS: Histopathological analysis demonstrated renal adenocarcinoma with pleomorphic areas. Immunohistochemical analysis showed a high cellular proliferation rate (Ki67) and intense expression of p53 and glycoprotein P. The patient developed metastasis to the brain four months later and pulmonary and cutaneous metastases shortly thereafter. CONCLUSIONS: Clear cell renal carcinoma can have a rapidly progressive course. Histological studies and determination of adverse immunohistological markers can be useful in these cases.

[Erythrocytosis and hydronephrosis in a horseshoe kidney]. / Poliglobulia e hidronefrosis, en riñón en herradura.

OBJECTIVE: To report a case of erythrocytosis in a patient with a hydronephrotic horseshoe kidney and normal erythropoietin values. METHODS/RESULTS: A hydronephrotic horseshoe kidney was discovered during evaluation to determine the etiology of the erythrocytosis in a 23-year-old male with normal erythropietin values. Blood parameters returned to normal following heminephrectomy. The hydronephrosis had been caused by stenois of the pyeloureteric junction. CONCLUSIONS: Although erythropoietin values may be normal, hydronephrosis can cause secondary erythrocytosis.

[Relapse in brucella orchiepididymitis]. / Recidiva en orquiepididimitis brucelosa.

This paper describes a case of systemic brucellosis accompanied by brucellar orchitis that resolved favourably. There was however a relapse at the testicular level inappropriately treated that triggered a new episode of systemic brucellosis.

[Squamous carcinoma of the male urethra, its presentation as a scrotal abscess]. / Carcinoma escamoso de la uretra masculina, presentación como absceso escrotal.

OBJECTIVE: To report a case of urethral carcinoma presenting as scrotal abscess. METHODS: A 53-year-old man presented with swelling, redness and pain in the scrotum. He had a history of urethral stricture and multiple scrotal abscesses. Incision and drainage were performed and the patient was treated with antibiotics without improvement. Incision and drainage were repeated and a biopsy of the tissue edges of the abscess were performed. RESULTS: Histopathological analysis disclosed a squamous cell carcinoma arising from the urethra. CONCLUSION: Patients with a history of urethral stricture should be followed closely. A scrotal biopsy should be performed in patients who do not improve with antibiotic therapy.

[A simple renal cyst, the origin of Wunderlich's syndrome]. / Quiste renal simple, origen de un síndrome de Wunderlich.

OBJECTIVE: An additional case of Wunderlich syndrome arising from a ruptured simple renal cyst is presented. METHODS/RESULTS: A 50-year-old female presented with pain, a mass in the left renal fossa and hypovolemia that could not be managed conservatively. The imaging techniques disclosed a large collection of blood in the left perirenal area. Surgical drainage of the hematoma and nephrectomy were performed. A simple cyst containing blood was found in the lower pole of the kidney. Its wall had been ruptured and had caused the hemorrhage. CONCLUSIONS: If surgical management of hemorrhage is decided in a patient with Wunderlich's syndrome, a conservative procedure should be performed and nephrectomy avoided if the underlying condition is benign.

[Results of ambulatory major surgery in urology, within an integrated unit]. / Realización de cirugía mayor ambulatoria en urología, dentro de una unidad integrada.

OBJECTIVE: To contribute our experience in the performance of ambulatory major surgery, through the creation of an integrated unit. Such units take advantage of existing resources both in terms of space and materials, as well as personnel, without the need to open separate ambulatory major surgery units that would involve greater resources expenditure. MATERIAL AND METHODS: 48 patients undergoing ambulatory major urology surgery were analyzed. The patients were admitted the same morning of the procedure and then, after leaving the operating theatre, they were moved to the reanimation room and later to the urology ward, where they were evaluated by the urologist on duty and discharged. A few days later the patients returned to the outpatient's clinic for re-evaluation. RESULTS: 48 patients underwent surgery, 44 male and 4 female. Mean age of patients was 34 (3-86) years. The procedures most frequently performed were: hydrocelectomy, vaginal peritoneum duct closure, orchiopexy, ureterorenoscopy due to ureteral lithiasis, internal urethrotomy, varicocelectomy, vesical tumor resection and circumcision in children. Only in two cases, hospital stay was longer than 12 hours and there was only one re-admission. CONCLUSIONS: Ambulatory major surgery integrated units may allow to perform this type of surgery in small units, with little resources and with a volume of patients not sufficient to create an independent unit.

[A renal cortical hemangioma simulating a carcinoma]. / Hemangioma renal cortical simulando un carcinoma.

OBJECTIVE: To report a case of renal cortical hemangioma. METHODS/RESULTS: A 38-year-old patient consulted for recurrent renal colic. The CT scan findings showed a cortical lesion in the right kidney that was compatible with a carcinoma. The patient underwent nephrectomy. Pathological analysis of the surgical specimen showed a 2.7 circumscribed cortical lesion that was found to be a hemangioma. CONCLUSION: Renal hemangioma localized to the renal cortex can mimic a carcinoma.

[The bilateral ureteral metastasis of a medullary carcinoma of the thyroid]. / Metástasis ureteral bilateral de carcinoma medular de tiroides.

OBJECTIVE: To describe a case of bilateral hydronephrosis arising from a medullary thyroid carcinoma that had metastasized to both ureters. METHODS/RESULTS: A case of bilateral hydronephrosis in an asthmatic 54-year-old female patient who consulted for recurrent bilateral nephric colic is described. The patient presented with severe impairment of renal function. Patient evaluation with imaging techniques could not identify the cause of the hydronephrosis. Bilateral ureteral catheterization improved renal function. The patient died from an episode of bronchospasm. Autopsy revealed a medullary carcinoma of the thyroid that had metastasized to several organs, including both ureters, causing hydronephrosis. CONCLUSIONS: In a patient presenting with bilateral hydronephrosis without a diagnosis of a primary tumor, it is difficult to suspect an underlying metastasis to the ureter. The imaging techniques are unable to detect small metastatic lesions.

[Intrascrotal malignant fibrous histiocytoma]. / Histiocitoma fibroso maligno intraescrotal.

OBJECTIVE: To describe a rare case of intrascrotal malignant fibrous histiocytoma. METHODS: A 90-year-old man presented with a scrotal mass which he had noted during the past few months. A scrotal tumor, 8 cm in diameter, was detected on physical evaluation. Tumor resection was decided due to the patient's good general condition despite his age. RESULTS: The histological analysis confirmed a sarcomatoid neoplasm with pleomorphism. The immunohistochemical analysis demonstrated strong overexpression of vimentin, alpha-1-antichymotrypsin, CD68 (Kpl), p53 oncoprotein and elevated Ki67. The ultrastructural study showed undifferentiated mesenchymal cells. The diagnosis of intrascrotal malignant fibrous histiocytoma was made based on the foregoing findings. CONCLUSIONS: Malignant fibrous histicytoma should be included in the differential diagnosis of intrascrotal tumors. Histological, immunohistochemical and ultrastructural studies are very important to distinguish the different paratesticular sarcomas. The strong overexpression of the p53 oncoprotein may be involved in the pathogenesis of this tumor type.