Prostate sarcoma: report of 2 cases and bibliographic review.

OBJECTIVE: To report two cases of prostate sarcoma and perform a review of the published literature. METHODS / RESULTS: The first case is a 21 year old patient who presented acute urine retention and lung metastases on diagnosis. He was diagnosed by TURP of rhabdomyosarcoma of the prostate dying 1 month after surgery. The second case was a 33 years old male who presented to the emergency room with anal pain, urinary symptoms, hematochezia and loss of 20 kg over the past 3 months. Abdominal CT scan showed an 11 x 10 x 9 cm mass in the lower pelvis that infiltrated the bladder and rectum, being unable to define its origin. CA 19.9, CEA and PSA were normal. The suspected diagnosis was a prostate sarcoma infiltrating rectum and bladder. A pelvic exenteration was performed with a wet colostomy. The pathologic diagnosis was a high grade sarcoma not clearly identified of the prostate. He was treated with adriamycin as adjuvant chemotherapy, having local recurrence, nodal involvement and multiple pulmonary metastases after 3 months of follow up CONCLUSIONS: Prostate sarcomas are rare tumors. This makes difficult to know their natural history. Their rapid progression and systemic spread, despite multimodal treatment, gives a mean survival of 24 months. Main survival factors are grade, a complete resection of the tumor and a low local stage. There is a need to find new chemotherapy protocols to increase survival rates as it has been shown in extremities sarcomas.

Sarcoma de próstata: presentación de 2 casos y revisión de la literatura / Prostate sarcoma: report of 2 cases and bibliographic review

OBJETIVO: Presentar dos casos de sarcoma de próstata y realizar una revisión de la literatura publicada. METODO/RESULTADO: El primer caso es un paciente de 21 años de edad que acudió por retención aguda de orina y metástasis pulmonares al momento del diagnóstico. Fue diagnosticado por RTU de rabdomiosarcoma de próstata falleciendo un mes después de la cirugía. El otro paciente era un varón de 33 años que acude a urgencias por proctalgia, síntomas miccionales, hematoquecia y pérdida de 20 kg durante los 3 últimos meses. El TAC abdominal muestra una gran masa de 11x10x9 cm en pelvis inferior que desplaza anteriormente la vejiga e infiltra el recto sin poder concretar su origen. Los marcadores CA 19.9, CEA y PSA/s no presentaban alteraciones. La RMN orientó hacia un sarcoma de próstata que infiltraba vejiga y recto. Se realizó una exanteración pélvica con colostomía húmeda. El diagnóstico definitivo fue de sarcoma fusocelular de próstata de alto grado con infiltración de recto y vejiga. Se administró tratamiento quimioterápico adyuvante con Adriamicina, presentando a los 3 meses recidiva local y múltiples metástasis pulmonares. CONCLUSIONES: Los sarcomas de próstata son tumores poco frecuentes, lo cual dificulta el conocimiento de su historia natural. La progresión local y a distancia es muy rápida, con una supervivencia media de 2 años, a pesar del manejo terapéutico multimodal. El principal factor de supervivencia es una resección completa del tumor y un estadío local poco avanzado. Es necesario buscar nuevos protocolos quimioterápicos que permitan prolongar la supervivencia de estos pacientes como se ha demostrado en otro tipo de sarcomas

OBJECTIVE: To report two cases of prostate sarcoma and perform a review of the published literature. METHODS / RESULTS: The first case is a 21 year old patient who presented acute urine retention and lung metastases on diagnosis. He was diagnosed by TURP of rhabdomyosarcoma of the prostate dying 1 month after surgery. The second case was a 33 years old male who presented to the emergency room with anal pain, urinary symptoms, hematochezia and loss of 20 kg over the past 3 months. Abdominal CT scan showed an 11 x 10 x 9 cm mass in the lower pelvis that infiltrated the bladder and rectum, being unable to define its origin. CA 19.9, CEA and PSA were normal. The suspected diagnosis was a prostate sarcoma infiltrating rectum and bladder. A pelvic exenteration was performed with a wet colostomy. The pathologic diagnosis was a high grade sarcoma not clearly identified of the prostate. He was treated with adriamycin as adjuvant chemotherapy, having local recurrence, nodal involvement and multiple pulmonary metastases after 3 months of follow up. CONCLUSIONS: Prostate sarcomas are rare tumors. This makes difficult to know their natural history. Their rapid progression and systemic spread, despite multimodal treatment, gives a mean survival of 24 months. Main survival factors are grade, a complete resection of the tumor and a low local stage. There is a need to find new chemotherapy protocols to increase survival rates as it has been shown in extremities sarcomas

Factores que afectan a la recurrencia postoperatoria de la enfermedad de Crohn. Nuevas controversias a través de la experiencia de un centro / No disponible

Introducción Muchos pacientes con enfermedad de Crohn presentan recurrencias frecuentes mientras otros mantienen periodos prolongados de remisión después de la cirugía. Determinar los factores de riesgo de recidiva puede ser útil para identificar pacientes de alto riesgo y poder adoptar estrategias adecuadas durante el acto quirúrgico y en la elección del tratamiento médico postoperatorio. Material y métodos Estudio retrospectivo de 78 pacientes con enfermedad de Crohn ileocólica sometidos a una primera cirugía resectiva durante el periodo de enero de 2000 a diciembre de 2005; posteriormente se han estudiado los factores de riesgo de recurrencia endoscópica, radiológica y quirúrgica hasta mayo de 2009. Resultados 41 pacientes (52,6%) tuvieron recurrencia; siendo en 17 pacientes (21,8%) endoscópica, en 12 (15,4%) radiológica y en 12 (15,4%) quirúrgica. El tiempo medio de la primera recurrencia es de 70,24 meses. El no realizar anastomosis durante la cirugía resectiva parece tener más relación con la existencia de recidiva (77,7% vs 48,2%). Aunque solo la existencia de complicaciones postoperatorias (p=0,018) tiene relación significativa con la existencia de recurrencia (68,4% vs 47,4%) así como la necesidad de transfusión en el periodo postoperatorio inmediato (67,8% vs 42,8%). Conclusiones La transfusión de hemoderivados es un factor de riesgo para la recurrencia postoperatoria de la enfermedad de Crohn. Pero solo las complicaciones postoperatorias se muestran como factor de riesgo independiente en el análisis multivariable. Una técnica quirúrgica adecuada y segura es un factor perioperatorio muy importante en el que podemos influir para disminuir esta recidiva (AU)

Introduction: Many patients with Crohn’s disease have frequent recurrences, while others have long periods of remission after surgery. Determination of the risk factors of recurrence would be useful in identifying these high risk patients and to adopt suitable strategies during the surgical act and in the choice of post-surgical medical treatment. Material and methods: A retrospective study was conducted on 78 patients with ileocolic Crohn’s disease subjected to a first surgical resection, during the period from January 2000 to December 2005. The risk factors for endoscopic, radiological and surgical were subsequently analysed up to May 2009.Results: A total of 41 patients (52.6%) had recurrences, being endoscopic in 17 (21.8%) of patients, radiological in 12 (15.4%) and surgical in 12 (15.4%). The mean time to first recurrence was 70.24 months. Recurrence was associated more to not performing anastomosis(77.7% vs. 48.2%) during surgical resection. Although only the existence of postoperative complications (P = .018) was significantly associated with (68.4% vs. 47.4%), as well as with the need for transfusion in the immediate post-operative period (67.8% vs. 42.8%). Conclusions: Transfusion of blood products is a risk factor for postoperative recurrence of Crohn’s disease. But only postoperative complications are shown as an independent risk factor in the multivariate analysis. An adequate and safe surgical technique is a very important perioperative factor over which we have the influence to decrease these recurrences (AU)