Experiencia quirúrgica en el adenocarcinoma de uraco / Surgical experience with urachal carcinoma

Introducción: Los adenocarcinomas de uraco constituyen menos de 1 % de las neoplasias malignas vesicales. El objetivo de esta investigación fue describir la experiencia médica y quirúrgica al respecto en nuestro centro hospitalario. Material y métodos: Estudio retrospectivo, descriptivo y observacional de pacientes con diagnóstico de cáncer vesical a quienes se les efectuó cistectomía radical con derivación urinaria o cistectomía parcial, seleccionando aquellos con informe patológico de adenocarcinoma de uraco entre enero de 1994 y mayo de 2007. Se analizó edad, sexo, sintomatología, métodos diagnósticos, abordaje quirúrgico, complicaciones y sobrevida. Resultados: De 306 pacientes, cinco (1.6 %) tuvieron adenocarcinoma del uraco: tres hombres (60 %) y dos mujeres (40 %), con edad promedio de 61 años. Dado que la hematuria constituyó el síntoma común, fueron abordados inicialmente con ultrasonido. En uno se documentó tumor de ovario derecho, por lo que se realizó laparotomía exploradora y cistectomía parcial en bloque. En cuatro se identificó tumor en domo vesical y se efectuó cistoscopia y resección transuretral vesical; el informe de patología sugirió adenocarcinoma de uraco y la tomografía axial computarizada lo confirmó, permitiendo la etapificación clínica IIIb de Sheldon en tres pacientes y IVa en uno. Se realizó cistectomía radical con neovejiga ortotópica tipo Studer. Cuatro pacientes se encuentran sin recurrencia y uno murió a consecuencia de la enfermedad. Conclusiones. Los adenocarcinomas de uraco tuvieron una incidencia de 1.6 % en la población estudiada. La sintomatología refleja en la mayoría de los casos patología vesical, por lo que son estudiados y abordados como tal. La cirugía es la mejor oportunidad de cura.

BACKGROUND: Urachal carcinomas are rare neoplasms that constitute <1% of bladder tumors. We undertook this study to describe the medical and surgical experience of urachal carcinomas treated in our hospital. METHODS: We carried out a retrospective, descriptive and observational study. Clinical files were reviewed of patients with diagnosis of bladder cancer and who were operated on with radical cystectomy with urinary substitution and extended partial cystectomy, selecting those patients with pathological report of urachal carcinoma. The study was conducted from January 1994 to May 2007 analyzing the following data: age, sex, symptoms, diagnostic methods, surgical approach, complications and disease-free survival. RESULTS: Of the 306 patients operated on with radical surgery for bladder cancer, only five patients (1.6%) had a diagnosis of urachal carcinoma. There were three (60%) men and two (40%) women, with a median age of 61 years. Hematuria was the chief complaint in all cases and the reason why they were initially treated with ultrasonography (USG). In one case, tumor of the right ovary was documented and the patient underwent exploratory laparotomy and extended partial cystectomy. In the other four cases, tumor was reported in the dome of the bladder and for this reason cystoscopy and transurethral resection of the bladder (TURB) were done, confirming the clinical findings in addition to the pathology report suggesting urachal carcinoma. Computed tomography (CT) confirmed the tumor in urachal topography, reporting a Sheldon clinical stage IIIb in three patients and stage IVa in one patient. This was the reason for the Studer-type orthotopic bladder substitution. Currently, four patients are being followed-up without recurrence, reporting only one death related to the disease. CONCLUSIONS: Urachal carcinomas are rare tumors with an incidence of 1.6% in our studied population. Symptoms in most cases are similar to those of bladder pathology origin. The surgical approach and procedure described here provide the best opportunity for disease-free survival.

[Lymphatic mapping and sentinel node biopsy in penis cancer. Feasibility study and preliminary report]. / Mapeo linfático y biopsia del ganglio centinela en cáncer de pene. Estudio de factibilidad y reporte preliminar.

Most patients with invasive squamous cell carcinoma of the penis do not have inguinal node metastasis at the time of diagnosis and 50% of those having palpable nodes are inflammatory. Penis cancer (PC) treatment implies resection of the primary tumor and inguinal lymphadenectomy; nevertheless, morbidity related to this procedure is high and its usefulness may be questioned in patients without metastasis in dissected nodes. Lymphatic mapping with sentinel node biopsy (LMSNB) is a valid alternative, useful in other neoplasias. The objective of this study is to determine if it is possible to identify a sentinel node (SN) in patients with PC. Patients with T1-2 PC without palpable nodes (N0) were included. LMSNB was carried out with the combined technique (blue dye and radiocolloid). All patients underwent an elective bilateral inguinal lymphadenectomy. Sensitivity and false negative index were calculated. SNs were sent for transoperative study with imprint technique and, definitively, with serial cuts and hematoxylin/eosin staining. Nine patients showed results with 32 lymph carrier zones and SN was identified in all of them, 4 regions had metastasis, in 3 the SN was metastatic and in one patient was metastasis-negative (false negative); sensitivity = 80%; false negatives index = 20%. Seven patients (77%) did not have node metastasis. LMSNB is an alternative for staging PC patients and could prevent unnecessary inguinal lymphadenectomies. A larger number of patients is required to validate the sturdy. The combined technique offers a high rate of success in SN identification.

[Renal tumor in a pelvic kidney. Case report]. / Tumor renal en riñón ectópico pelvico presentación de un caso.

OBJECTIVE: An uncommon association of renal cell carcinoma in a pelvic kidney is described, the literature is reviewed. METHODS: A case of renal cell carcinoma in a pelvic kidney is presented, and the literature briefly reviewed, with special reference to six cases reported. RESULTS: Renal cell carcinoma in a pelvic kidney is uncommon, the paucity of previous reports of this association is surprising. Besides renal cell carcinoma is the most common malignant renal tumour in the adult and renal ectopy is relatively common more cases of this association would be expected. CONCLUSIONS: Renal cell carcinoma is the most common malignant renal tumour in the adult and renal ectopy is relatively common, the actual incidence among autopsy series is 1 in 900, it has been an uncommon association, with only six cases reported. The surgical approach to ectopic kidneys merits caution because of the uncertain vascular anatomy, and vascular studies may be indicated to avoid complications, the present case is important because it represent the most common urological cancers at our institution with an unusual presentation.

Tumor renal en el riñón ectópico pélvico. Presentación de un caso / No disponible

OBJETIVOS: Presentar un caso de carcinoma de células renales en un riñón ectópico pélvico, siendo esta una asociación poco frecuente. Revisamos la literatura existente. METODO: Se presenta un caso clínico de un tumor renal en un riñón ectópico pélvico y revisamos literatura, revisan- do los 6 casos publicados en la literatura (3, 5, 7, 8, 9). RESULTADOS: El carcinoma de células renales en un riñón ectópico pélvico es infrecuente, siendo la escasez de reportes previos sorprendente, ya que el carcinoma de células renales es el tumor renal más común en el adulto y la ectopia renal es relativamente frecuente, más casos con esta asociación se esperarían (8). CONCLUSIONES: El carcinoma de células renales es el tumor renal mas común en los adultos y la ectopia renal se presenta actualmente con una incidencia de 1 en 900 autopsias (8), siendo esta una asociación rara, habiendo solo 6 casos reportados en la literatura. Su abordaje quirúrgico debe ser con cautela ya que la anatomía vascular es incierta y se deben realizar los estudios preoperatorios necesarios para evitar complicaciones, el presente caso es importante ya que representa el tumor urológico mas frecuente en nuestro centro con una presentación inusual (AU)

OBJECTIVE: An uncommon association of renal cell carcinoma in a pelvic kidney is described, the literature is reviewed. METHODS: A case of renal cell carcinoma in a pelvic kidney is presented, and the literature briefly reviewed, with special reference to six cases reported. RESULTS: Renal cell carcinoma in a pelvic kidney is uncommon, the paucity of previous reports of this association is surprising. Besides renal cell carcinoma is the most common malignant renal tumour in the adult and renal ectopy is relatively common more cases of this association would be expected. CONCLUSIONS: Renal cell carcinoma is the most common malignant renal tumour in the adult and renal ectopy is relatively common, the actual incidence among autopsy series is 1 in 900, it has been an uncommon association, with only six cases reported. The surgical approach to ectopic kidneys merits caution because of the uncertain vascular anatomy, and vascular studies may be indicated to avoid complications, the present case is important because it represent the most common urological cancers at our institution with an unusual presentation (AU)