Retroperitoneal cystic mature teratoma as the presenting clinical scenario of testicular carcinoma.

OBJECTIVE: To describe a case of retroperitoneal mature teratoma presenting as metastasis of a testicular mixed germ cell tumor in a thirty year old man who had lumbar and abdominal pain and mass sensation in the left hemiabdomen. METHODS: Abdominal ultrasound and thoracic-abdominal-pelvic CT multidetector scan were performed, and then after a Doppler ultrasound study of the testicles. Surgical treatment was performed: orchiectomy and retroperitoneal lesion resection. RESULTS: Imaging studies showed a big cystic lesion in the left retroperitoneal space, 13 × 12 × 11 cm, well defined, with thin septa, displacing the kidney; and a solid-cystic 4 cm left testicular tumor, with multiple septa, solid poles and arterial flows with low resistances. Thoracic extension study did not show any finding. The histopathologic results of the orchiectomy and retroperitoneal resection pieces were, respectively, testicular mixed germ cell tumor (seminoma, with intratubular seminoma foci and teratoma) and mature cystic teratoma. CONCLUSIONS: Germ cell tumors derive from multipotencial cells with a large capacity of differentiation, and the nodal paraaortic chains are a natural way of dissemination of these neoplasms. Because of that, in the presence of a retroperitoneal lesion in a young patient we have to rule out testicular tumor metastasis. The retroperitoneal mature cystic teratoma must be considered as a lesion with malignant potential.

Teratoma quístico maduro retroperitoneal como primera manifestación de carcinoma testicular. Estudio radiológico / Retroperitoneal cystic mature teratoma as the presenting clinical scenario of testicular carcinoma. Radiological study

OBJETIVO: Describir un caso de teratoma maduro retroperitoneal como metástasis de un tumor mixto de células germinales testicular en un paciente de 30 años que debutó con dolor lumbar, abdominal y sensación de masa en hemiabdomen izquierdo.MÉTODOS: Se realizó ecografía abdominal, TC multidetector tóraco-abdomino-pélvico, y ante los hallazgos apreciados ecografía-doppler testicular. Se practicó orquiectomía y resección de la lesión retroperitoneal. RESULTADOS: En las pruebas de imagen se apreció a nivel retroperitoneal izquierdo una gran lesión quística de 13x12x11 cm de diámetro, bien delimitada, con finos septos, que desplazaba el riñón; y una masa testicular de 4 cm, sólido-quística, multiseptada, con polos sólidos y flujos vasculares arteriales de baja resistencia. El estudio de extensión torácico no mostró hallazgos. Los resultados anatomopatológicos de las piezas de orquiectomía y de la lesión retroperitoneal fueron respectivamente: tumor mixto de células germinales (seminoma, con focos de seminoma intratubular y teratoma), y teratoma quístico maduro.CONCLUSIONES: Debido a que los tumores de células germinales derivan de células multipotenciales con gran capacidad de diferenciación y que las cadenas ganglionares paraaórticas constituyen una vía de diseminación natural de estas neoplasias, la presencia de una lesión retroperitoneal en un paciente joven, aún sin signos radiológicos de malignidad (en nuestro caso quística) obliga a descartar metástasis de tumor testicular. El teratoma maduro retroperitoneal postpuberal debe considerarse una lesión con potencial maligno(AU)

OBJECTIVE: To describe a case of retroperitoneal mature teratoma presenting as metastasis of a testicular mixed germ cell tumor in a thirty year old man who had lumbar and abdominal pain and mass sensation in the left hemiabdomen.METHODS: Abdominal ultrasound and thoracic-abdominal-pelvic CT multidetector scan were performed, and then after a Doppler ultrasound study of the testicles. Surgical treatment was performed: orchiectomy and retroperitoneal lesion resection.RESULTS: Imaging studies showed a big cystic lesion in the left retroperitoneal space, 13 x 12 x 11 cm, well defined, with thin septa, displacing the kidney; and a solid-cystic 4 cm left testicular tumor, with multiple septa, solid poles and arterial flows with low resistances. Thoracic extension study did not show any finding. The histopathologic results of the orchiectomy and retroperitoneal resection pieces were, respectively, testicular mixed germ cell tumor (seminoma, with intratubular seminoma foci and teratoma) and mature cystic teratoma.CONCLUSIONS: Germ cell tumors derive from multipotencial cells with a large capacity of differentiation, and the nodal paraaortic chains are a natural way of dissemination of these neoplasms. Because of that, in the presence of a retroperitoneal lesion in a young patient we have to rule out testicular tumor metastasis. The retroperitoneal mature cystic teratoma must be considered as a lesion with malignant potential(AU)

[Diagnostic utility of nail biopsy: a study of 15 cases]. / La biopsia ungueal: un método diagnóstico de gran utilidad. Estudio de 15 casos.

INTRODUCTION: Nail biopsy is thought to be a useful technique for the diagnosis of diseases affecting the nail apparatus and may help avoid delays in the diagnosis of important mucocutaneous diseases. Furthermore, it has therapeutic value in its own right. It is not a difficult technique to perform but it requires an in-depth knowledge of the anatomy and physiology of the nail unit, as well as surgical experience and patient collaboration. In order to assess the diagnostic utility of this technique, we reviewed the nail biopsies performed in our department between June 2005 and May 2006. PATIENTS AND METHODS: We identified 15 patients in whom nail biopsy had been performed. The clinical findings, type of biopsy performed, and histopathologic diagnosis were assessed. RESULTS: Nail biopsy allowed diagnosis of a variety of skin disease in 13 out of 15 patients (psoriasis in 5, onychomycosis in 4, melanonychia in 2, melanoma in 1, and subungual hematoma in 1). None of the patients presented sequelae as a result of the intervention after several months of follow-up. CONCLUSION: Nail biopsy is a useful tool in cases in which the patient history, clinical presentation, and additional tests have not led to a definitive diagnosis. In our experience, it can be performed safely and with minimal scarring.

La biopsia ungueal: un método diagnóstico de gran utilidad. Estudio de 15 casos / Diagnostic utility of nail biopsy: a study of 15 cases

Introducción. La biopsia ungueal se considera una técnica útil en el diagnóstico de los procesos patológicos que afectan al sistema ungueal y que permite evitar el retraso en el diagnóstico de procesos cutáneo-mucosos y anexiales importantes. Además, tiene por sí misma un valor terapéutico. No es una técnica difícil de realizar, pero requiere un completo conocimiento de la anatomía y la fisiología ungueal, así como de experiencia quirúrgica y colaboración del paciente. Con el objetivo de evaluar la utilidad diagnóstica de esta técnica hemos revisado las biopsias ungueales realizadas en nuestro servicio desde junio de 2005 hasta mayo de 2006. Pacientes y métodos. Se incluyó a 15 pacientes a los que se les realizó una biopsia ungueal. Se valoraron los aspectos clínicos de la patología, el tipo de biopsia realizada y el diagnóstico histopatológico. Resultados. La biopsia ungueal permitió un diagnóstico de diversas patologías cutáneas en 13 de los 15 pacientes (5 psoriasis, 4 onicomicosis, 2 melanoniquias longitudinales, 1 melanoma y 1 hematoma subungueal).Ninguno de los pacientes presentó secuelas de la intervención tras varios meses de seguimiento. Conclusión. La biopsia ungueal es una herramienta útil en aquellos procesos en los que por la historia, la clínica y los estudios complementarios no se haya podido establecer un diagnóstico exacto. Según nuestra experiencia puede ser realizada de forma segura y con un mínimo daño cicatricial (AU)

Introduction. Nail biopsy is thought to be a useful technique for the diagnosis of diseases affecting the nail apparatus and may help avoid delays in the diagnosis of important mucocutaneous diseases. Furthermore, it has therapeutic value in its own right. It is not a difficult technique to perform but it requires an in-depth knowledge of the anatomy and physiology of the nail unit, as well as surgical experience and patient collaboration. In order to assess the diagnostic utility of this technique, we reviewed the nail biopsies performed in our department between June 2005 and May 2006. Patients and methods. We identified 15 patients in whom nail biopsy had been performed. The clinical findings, type of biopsy performed, and histopathologic diagnosis were assessed. Results. Nail biopsy allowed diagnosis of a variety of skin disease in 13 out of 15 patients (psoriasis in 5, onychomycosis in 4, melanonychia in 2, melanoma in 1, and subungual hematoma in 1). None of the patients presented sequelae as a result of the intervention after several months of follow-up. Conclusion. Nail biopsy is a useful tool in cases in which the patient history, clinical presentation, and additional tests have not led to a definitive diagnosis. In our experience, it can be performed safely and with minimal scarring (AU)