Tumores no germinales de testículo / Non germinal cell testicular tumors

OBJETIVO: Presentamos una revisión de las tumoraciones testiculares intervenidas en nuestro Hospital durante 13 años. Fueron 151 piezas, de las que 50, la tercera parte, se diagnosticaron de origen no germinal (33%).MÉTODO/RESULTADOS: De éstas, el 42% resultaronsecundarias a tumores hematopoyéticos, linfomas y leucemias. El 30% correspondieron al grupo de formacionesno neoplásicas donde se encuadraron los tumoresvasculares y las orquitis granulomatosas. El 12% se identificaron como tumores de células de Leydig y de Sertoli. El 10% fueron provocados por metástasis de otros tumores.CONCLUSIÓN: Los tumores no germinales afectaron en nuestra serie más a adultos, 78%, que a niños, 22%. En éstos el 82% de las neoformaciones está representadopor la infiltración leucémica.El origen no germinal no tiene porqué significar mejor pronóstico

OBJECTIVES: We report a review of all patients with testicular tumors undergoing surgery in our Hospital over a 13 year period. There were 151 cases, 50 of them were reported as non germ cell tumors (33%). METHODS/RESULTS: 42% of them were haematopoietic tumors, lymphomas and leukemias. 30% of them were non neoplastic tumors, including vascular tumors and granulomatous orchitis. 12% were identified as Leydig or Sertoli cell tumors. 10% were metastases. CONCLUSIONS: Non germ cell tumors were more frequent in adults (78%) than in children (22%). Among children, 82% of the neoplasias were leukemic infiltration of the testicle. Non germ cell tumors do not imply a better prognosis

[Non germinal cell testicular tumors]. / Tumores no germinales de testículo.

OBJECTIVES: We report a review of all patients with testicular tumors undergoing surgery in our Hospital over a 13 year period. There were 151 cases, 50 of them were reported as non germ cell tumors (33%). METHODS/RESULTS: 42% of them were haematopoietic tumors, lymphomas and leukemias. 30% of them were non neoplastic tumors, including vascular tumors and granulomatous orchitis. 12% were identified as Leydig or Sertoli cell tumors. 10% were metastases. CONCLUSIONS: Non germ cell tumors were more frequent in adults (78%) than in children (22%). Among children, 82% of the neoplasias were leukemic infiltration of the testicle.

[Paratesticular leiomyosarcoma. Review and update]. / Leiomiosarcoma paratesticular. Revisión y puesta al día.

OBJECTIVES: To present one case of paratesticular leiomyosarcoma, a rare tumor which has been reported in 5 cases only in our country. To review the management of this type of tumor. METHODS: A 73-year-old male presenting with a 4 cm mass adjacent to the right testicle underwent excision of the mass, spermatic cord and testicle through an inguinal approach. RESULTS: The tumor was classified as a grade 3 leiomyosarcoma, with positive immunohistochemical staining for desmin and smooth muscle actin. After this pathology report we did not consider adjuvant oncological treatment. Tumor relapse has not appeared so far. CONCLUSIONS: Radical surgery is the only feasible and successful treatment for paratesticular sarcomas, with the exception of rabdomyosarcoma, because they are radio and chemoresistant. 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 occur even long time after diagnosis. In case of relapse, surgery is again the only tool we have to control this type of tumor. Currently radiotherapy is recommended in cases of local recurrence after surgery. 5-year survival rates are around 75%, and 10-year 50%.

[Adrenal spindle cell angiosarcoma. Report one case]. / Angiosarcoma suprarrenal de células fusiformes. A propósito de un caso.

OBJECTIVES: To report a new case of spindle cell angiosarcoma of the adrenal gland. METHODS: We reviewed 22 cases previously published of this rare entity, analyzing at the same time both clinical and pathologic findings of this infrequent sarcoma of urological localization. The epithelioid variety is the most common, which makes our spindle cell type case rarer, if possible. RESULTS: 59-year-old male without significant previous medical history presenting at the emergency department with sudden onset of pain in the left hemithorax after several months of discomfort in the area. Diagnostic imaging tests showed a heterogeneous mass dependent of the left kidney. After performing radical nephrectomy and adrenalectomy, pathologic and immunohistochemical studies offered the diagnosis. CONCLUSIONS: Despite the rarity of these tumors it should be taken into consideration in the differential diagnosis of every adrenal tumor. Complete surgical excision is the treatment of choice, adding systemic chemotherapy as adjuvant therapy; radiotherapy is reserved as a second line after excision of recurrences if there are.

[Testicular leukemic infiltration]. / Infiltración leucémica testicular.

OBJECTIVES: To remind that despite its low incidence, leukemic relapse in the testicles worsens the prognosis of this haematopoietic neoplasia. METHODS/RESULTS: We report the case of a 20-year-old male suffering from acute lymphoblastic leukemia in complete remission after induction and maintenance treatment, who suffered a leukemic relapse in both testicles. Diagnosis was made by ultrasound and confirmed after bilateral testicular biopsies. The patient died due to fungal infection after new treatment with systemic chemotherapy and bone marrow transplantation. CONCLUSIONS: It is necessary to suspect the existence of leukemic cells within the testicles in patients with this disease, mainly acute lymphoblastic leukemia, who present with acute testicular symptoms. Testicular biopsy confirms the diagnosis. Treatment is systemic, with testicular radiation to eradicate the leukemic reservoir. Despite the achievement of local disease control, this situation worsens the prognosis.

[Urachal cyst. Current status]. / Quiste de uraco. Estado actual.

OBJECTIVES: We report one case of urachus diverticulum. It is very rare in adults so that the level of diagnostic suspicion is low. METHODS: 50-year-old male without history of urologic diseases who presented with recurrent urinary tract infections over a two-year period. There were not findings on physical examination. Abdominal ultrasound showed a 3 x 2 cm cystic image with internal echoes on the bladder dome. CT scan confirmed the cystic lesion which thickened the bladder wall at the dome. The patient underwent surgery for the excision of a suspected urachal cyst. RESULTS AND CONCLUSIONS: In order of frequency, the 4 types of urachal congenital abnormalities are: permeable urachus (50%), urachal cyst (30%), urachal sinus (15%), and urachal diverticulum (5%). The indication of surgery comes from the possibility of infection and malignant transformation; the cyst should be excised with a bladder dome cuff due to the risk of existence of urachal remnants at that level and their potential to degenerate to adenocarcinoma.

[Prostatic ductal carcinoma]. / Carcinoma ductal prostático.

OBJECTIVES: We presented one case of prostatic adenocarcinoma of ductal origin, known as endometrial adenocarcinoma before. The first case was published in 1967 by Mellicow. Since then we could only recover 8 cases by spanish authors. METHODS/RESULTS: 61-year-old patient presenting with urethral bleeding, PSA 12 ng/cc, and an exophytic urethral mass. Histology was compatible with ductal adenocarcinoma of the cribiform type. Radical prostatectomy was carried out with good outcome at six months follow up. CONCLUSIONS: Prostatic ductal adenocarcinoma is a rare tumor, accounting for 0.2-5% of prostatic tumours. Its behaviour is variable, similar to the acinar cell type. Strikingly, there are scarce references to this tumor type; accordingly to the statistics of incidence it should have been referred more often, which would help to its study in terms of outcomes, treatment, and prognosis.

[Foamy carcinoma of the prostate]. / Carcinoma espumoso de la próstata.

OBJECTIVES: We report the first case of prostatic foamy gland carcinoma in the Spanish literature. METHODS: Case of a 69-year-old male who consulted for PSA elevation up to 101 ng/ml. Transrectal ultrasound showed a heterogeneous gland with a hipoechogenic area in the right lobe and possible capsular disruption. Six ultrasound guided needle biopsies were performed. The samples from the right lobe were reported as Gleason 6 foamy cell prostatic adenocarcinoma. RESULTS: Prostatic foamy cell carcinoma is a rare tumor, and so are its bibliographic references. Its cells lack of prominent nucleus and nucleoli. They show a plentiful and xanthomatous cytoplasm, with abundant intracytoplasmic pink secretions characteristically. It may be mistaken with low grade adenocarcinomas, and it is essential to differentiate it from the clear cell prostatic adenocarcinoma, prostatic adenosis, and even from benign prostatic hyperplasia. It usually has an intermediate grade, with a Gleason score greater than 4.

[Bilateral renal solitary fibrous tumor]. / Tumor fibroso solitario renal bilateral.

OBJECTIVES: We report the first case of bilateral renal solitary fibrous tumor diagnosed in a patient suffering from tuberous sclerosis. METHODS: From the bibliographic review, only 15 cases of solitary fibrous tumor have been described in the kidney. We did not find any case of simultaneous bilateral involvement. We did not find any case described in a patient with tuberous sclerosis either, as the present case, being a 51-year-old female with presenting with a big abdominal mass arising from the left kidney (25 cm) and another 2 cm mass in the right kidney. CONCLUSIONS: We emphasize the extreme rarity of this tumor in the kidney. It has benign characteristics and behavior, and good prognosis, but requires surgical treatment to obtain a proper histopathologic diagnosis, based on immuno-histochemical studies.

Carcinoma ductal prostático / Prostatic carcinoma of ductal origin

OBJETIVOS. Presentamos un caso de adenocarcinoma ductal prostático, conocido hasta poco como carcinoma endometrioide. El primer caso publicado lo fue en 1967 por Mellicow. Desde entonces tan solo hemos recogido 8 casos expuestos por autores de nuestro país. MÉTODOS Y RESULTADOS: Paciente de 61 años, con uretrorragia, PSA de 12 ng/cc, que presentó masa uretral exofítica.La histología fue compatible con adenocarcinoma ductal de tipo cribiforme. Fue sometido a prostatectomía radical. Buena evolución a los 6 meses. CONCLUSIONES. El adenocarcinoma ductal de próstata es un raro tipo tumoral, que supone entre el 0'2 y el 5 por ciento de los tumores prostáticos según estadísticas. De comportamiento variable, similar al tipo acinar. Resulta extraño la escasa referencia a este tipo tumoral, ya que estadísticamente debiera de aparecer referenciado más a menudo, lo que ayudaría a su estudio en cuanto a evolución, tratamiento y pronóstico (AU)

Quiste de uraco. Estado actual / Urachal cyst. Current status

OBJETIVO: Presentamos un caso de patología uracal, concretamente un quiste. En el adulto es muy poco frecuente presentando por lo tanto un bajo índice de sospecha diagnóstica. MÉTODO: Varón de 50 años sin antecedentes urológicos de interés que consulta por infecciones urinarias recidivantes de unos 2 años de evolución. Exploración física anodina. Ecográficamente se demostró una imagen quística de 3 x 2 cm con ecos internos localizada en cúpula vesical. La TAC confirma la lesión quística que engrosa la pared vesical a nivel de la cúpula. Con sospecha de quiste uracal se procedió a su exéresis. RESULTADOS Y CONCLUSIONES: Los 4 tipos de anormalidades congénitas del uraco son por orden de frecuencia: uraco permeable (50 por ciento), quiste de uraco (30 por ciento), seno uracal (15 por ciento) y divertículo uracal (5 por ciento). La indicación de intervención quirúrgica viene dada por la posibilidad de infección y transformación maligna, debiendo resecarse el quiste acompañado de un rodete de cúpula vesical por el riesgo de existencia de restos uracales a ese nivel y su potencial degenerativo a adenocarcinoma (AU)

Infiltración leucémica testicular / Testicular leukemic infiltration

OBJETIVOS: Recordar que la recaída leucémica a nivel testicular, a pesar de su escasa incidencia, empeora el pronóstico de esta neoplasia hematopoyética. MÉTODOS/RESULTADOS: Presentamos el caso de un varón de 20 años afecto de leucemia linfoblástica aguda en remisión tras tratamiento de inducción y mantenimiento, que sufrió una recaída leucémica a nivel de ambos testículos. Fue diagnosticado por ecografía y confirmado tras biopsia testicular bilateral. Tras nuevo tratamiento con quimioterapia sistémica y trasplante de médula ósea falleció por infección fúngica. CONCLUSIONES: Es preciso sospechar la existencia de células leucémicas a nivel testicular en pacientes afectados por esta enfermedad, sobre todo de leucemia linfoblástica aguda, que se presentan con sintomatología aguda testicular. La biopsia testicular confirmará el diagnóstico. El tratamiento se instaurará a nivel sistémico, debiéndose recurrir a la irradiación testicular, para "aniquilar" el reservorio leucémico. A pesar de conseguir controlar la enfermedad local esta situación ensombrece el pronóstico (AU)

Tumor fibroso solitario renal bilateral / Bilateral renal solitary fibrous tumor

OBJETIVOS: Presentamos el primer caso de tumor fibroso solitario renal bilateral diagnosticado en una paciente afecta de esclerosis tuberosa. MÉTODO / RESULTADOS: Tan solo han sido descritos 15 casos de tumor fibroso solitario a nivel renal en toda la literatura consultada. No hemos encontrado ningún caso de afectación bilateral simultánea. Tampoco hemos localizado ningún caso descrito en paciente con esclerosis tuberosa, como nuestro caso, de 51 años diagnosticada de gran masa abdominal dependiente de riñón izdo (25 cm), coexistente con otra de 2 cm localizada en riñón dcho. CONCLUSIONES: Destacamos la extremada rareza de este tipo tumoral a nivel renal de características y comportamiento benigno, de buen pronóstico, pero que requiere tratamiento quirúrgico de exéresis para su correcto diagnóstico histopatológico, basado en estudios inmunohistoquímicos. (AU)

Carcinoma espumoso de la próstata / Prostatic foamy gland carcinoma

OBJETIVO: Presentamos el primer caso de carcinoma prostático espumoso descrito en literatura española. MÉTODO: Se trata de un varón de 69 años que consultó por elevación de PSA de 101 ng/ml. Mediante ecografía transrectal se visualiza una glándula heterogénea, con hipoecogenicidad en lóbulo derecho y posible dirrupción capsular. Se realizan 6 biopsias ecodirigidas con aguja. Las correspondientes a lóbulo derecho son informadas como adenocarcinoma prostático de células espumosas de Gleason 6. RESULTADOS: El carcinoma espumoso prostático es un tumor poco frecuente, y por ello escasamente referenciado. Sus células carecen de núcleo y nucleolos prominentes. Presentan citoplasma abundante y xantomatoso, siendo características unas abundantes secreciones rosas intraluminales. Puede confundirse con adenocarcinomas de bajo grado, siendo fundamental distinguirlo del adenocarcinoma de células claras prostático, de la adenosis, incluso de la hiperplasia benigna. El grado acostumbra a ser intermedio, con suma de Gleason superior a 4. CONCLUSIONES: Es importante su reconocimiento como entidad, ya que a pesar de su apariencia benigna el tratamiento y manejo del carcinoma espumoso no difieren del resto de adenocarcinomas, consistiendo tan solo en una variedad histopatológica de los tumores malignos prostáticos (AU)

Endometrioma urinario / Urinary endometrioma

OBJETIVOS: Analizar los casos descritos en nuestro país de endometriosis con afectación urológica. MÉTODO/RESULTADOS: Hemos encontrado un total, contando nuestro caso, de 26 endometriosis, de las cuales 15 fueron vesicales y los 11 restantes ureterales. El tratamiento realizado es variable, independientemente de la localización de la afectación vesical o ureteral. Desde resección transuretral y laserificación hasta cistectomía parcial, en los casos vesicales. Desde ureterectomías segmentarias con reimplante ureterovesical hasta nefrectomía en los casos ureterales. CONCLUSIONES: La resolución definitiva de los endometriomas urinarios es quirúrgica. El tratamiento definitivo de la endometriosis debe realizarlo el ginecólogo, mediante terapia hormonal y quirúrgica según ciertas connotaciones, como la edad de la paciente, gravedad y localización de las lesiones, deseo de descendencia posterior, severidad de las lesiones y tolerancia a la hormonoterapia (AU)

[Hyperdense renal cyst]. / Quiste hiperdenso renal.

OBJECTIVE: We update the diagnostic criteria for renal cystic masses, emphasising in the clinical entity known as hyperdense renal cyst. METHODS: We report the case of a male patient who presented with an atypical left renal cyst. Radiological examinations (US and CT) were performed. A description of renal cyst classification is made. We review the diagnostic criteria for hyperdense renal cyst using the iconography from this case and also its therapeutic approach. RESULTS: An image compatible with left simple renal cyst was found on ultrasound. A CT scan study showed an homogeneous mass with a high attenuation value, non vascular in nature, which complies with all diagnostic criteria for hyperdense renal cyst. CONCLUSIONS: Hyperdense renal cyst is a simple cyst which has suffered bleeding or infection. Diagnosis is made by CT scan and it does not require treatment.

Quiste hiperdenso renal / Hyperdense renal cyst

Objetivos: Actualizamos los criterios diagnósticos de las masas quísticas renales, haciendo énfasis en la entidad conocida como quiste hiperdenso renal.Métodos: Presentamos el caso de un paciente varón que consulta por quiste atípico renal izquierdo. Se practicó estudios de imagen (eco y TAC). Se realiza una descripción de la clasificación de quistes renales. Se revisan los criterios diagnósticos de quiste hiperdenso apoyados con la iconografía del caso y la actitud a tomar ante esta entidad.Resultados: Se evidenció mediante eco una imagen compatible con quiste simple renal izquierdo. En el estudio mediante TAC se objetiva una masa homogénea de alto valor de atenuación de naturaleza avascular que cumple todos los criterios de quiste hiperdenso renal.Conclusiones: El quiste hiperdenso es un quiste simple que ha sufrido hemorragia o infección. Su diagnóstico se realiza mediante TAC y no precisa tratamiento (AU)

[Urinary endometrioma]. / Endometrioma urinario.

OBJECTIVES: To analyze the series of cases of endometriosis with urologic involvement reported in our country. METHODS/RESULTS: We found a total of 26 cases of endometriosis including our case, 15 affected bladder and 11 ureter. Independently of ureteral or bladder location, the treatment performed varied, from transurethral resection and laser to cystectomy in cases involving bladder, from segmental ureterectomy with ureteral reimplantation to nephrectomy in ureteral cases. CONCLUSIONS: Surgery is the definitive solution for urinary tract endometriomas. The definitive treatment of endometriosis must be done by gynecologists, by means of hormonal and surgical treatment depending on age, severity and location of the lesions, patient's wishes for future pregnancies, and tolerance to hormone therapy.