[Bladder carcinoma with osteoclast-type giant cells. A case with a rare presentation. Review of the literature]. / Carcinoma con células gigantes tipo osteoclasto de vejiga. Un caso de rara presentación. Revisión de la literatura.

We report a case of neoplasm of the urinary bladder with pseudosarcomatous stromal differentiation. Heterologous carcinosarcomas are extremely rare malignant neoplasms (seventy-eight cases have been previously described). This is a case of carcinoma containing numerous osteoclast type giant cells that stained for vinmentin and acid phosphatase and were negative for cytokeratin and lysozyme.

Carcinoma con células gigantes tipo osteoclasto de vejiga. Un caso de rara presentación. Revisión de la literatura / Giant osteoclast type cell carcinoma of the urinary bladder. A case with unusual presentation. Review of the literature

Presentamos un caso de tumor vesical con diferenciación pseudosarcomatosa del estroma.Son extremadamente raros (sólo se había descrito 78 casos en el mundo hasta el año 2001).También son llamados carcinosarcomas heterólogos, dentro de los cuales se encuentran los llamados carcinosarcomas con células gigantes tipo osteoclasto, que se caracterizan por ser positivos para vimentina y fosfatasa ácida y negativos para marcadores epiteliales (citoqueratinas de bajo peso y lisozima) (AU)

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[Hemorrhagic cystitis caused by BK and JC polyomavirus in patients treated with bone marrow transplantation: clinical features and urologic management]. / Cistitis hemorrágica por poliomavirus BK y JC en pacientes sometidos a transplante de médula ósea: aspectos clínicos y manejo urológico.

INTRODUCTION: Differential diagnosis of hematuria after bone marrow transplantation (B.M.T.) may include polyomavirus (BK and JC)-associated haemorrhagic cystitis. Many reports have implied BK virus as the major pathogen in the development of hemorrhagic cystitis after BMT. BK viruria is also associated with ureteric stenosis in renal allografts recipients. Viral urinary tract infections are uncommon in healthy individuals, but we can find them frequently in patients under immunosuppressive conditions. MATERIAL AND METHODS: Retrospective study of 123 consecutive B.M.T. recipients in the period from 1995 to 2000, evaluating those with polyomavirus-associated hemorrhagic cystitis. We present patient's characteristics, primary disease, clinical features, diagnosis aspects and treatment of these "hidden hosts of urinary tract". RESULTS: 7 patients (5.7% of B.M.T.) developed BK or JC virus-associated hemorrhagic cystitis; 3 men and 4 women; median patient age was 29 years (range 14 to 45 years). Bacterial, mycobacterial and parasitic urine cultivates had negative results in all of them. The clinical course was characterized by a late onset of haemorrhagic cystitis (days +30 to +132 after BMT). All 7 patients developed macroscopic haematuria (duration 3 to 30 days). In 6 cases Graft Versus Host Disease (G.V.H.D.) criteria were found. Ultrasonographic studies revealed diffuse thickening of bladder wall in 5 patients. Hematuria was managed by hyperhydratation, blood transfusions, transurethral catheter and evacuation of blood clots, continuous bladder irrigation, urine alkalinization and antiviral therapy. No other more aggressive measures were required to stop the bleeding. Only 1 case of transient elevated creatinine. CONCLUSIONS: Polyomavirus-associated haemorrhagic cystitis must be considered in differential diagnosis of hematuria in bone marrow transplantation recipients. Urological management, according with the severity and duration of hematuria, is frequently required.

[Extramedullary hematopoiesis, a simulator difficult to diagnose]. / Hematopoyesis extramedular, un simulador de difícil diagnóstico.

The extramodular hematopoiesis is the result of the bone marrow sever chronical hypofunction, being the genitourinary affection very unusual. We are presenting a singular case by its own clinicopathology consequences and exceptional incidence in context of a upper tract urothelial tumor.

Cistitis hemorrágica por poliomavirus BK y JC en pacientes sometidos a trasplante de medula osea: aspectos clínicos y manejo urológico / Polyomavirus BK and JC associated haemorrhagic cystitis in patients under bone marrow transplantation clinical features and urological management

INTRODUCCION: Dentro del diagnóstico diferencial de la hematuria en pacientes receptores de un trasplante de médula ósea (T.M.O.) debemos considerar la cistitis hemorrágica por poliomavirus BK y JC. Algunos han implicado al virus BK como el principal agente en su desarrollo. La viruria por BK también se ha asociado a estenosis ureteral en pacientes sometidos a trasplante renal. Las infecciones urinarias virales, excepcionales cuando existe indemnidad del sistema inmune, pueden aparecer con frecuencia en situaciones de inmunocompromiso.MATERIAL Y MÉTODOS: Estudio retrospectivo de 123 pacientes consecutivos sometidos a trasplante de médula ósea (1995-2000). analizando los casos en que se presentó cistitis hemorrágica con aislamiento de poliomavirus BK y JC en orina. Se estudian: características poblacionales, enfermedad de base, manifestaciones clínicas y radiológicas, métodos diagnósticos y medidas terapéuticas. Realizamos una revisión de los principales aspectos de estos "desconocidos huéspedes del aparato urinario".RESULTADOS: Se presentó cistitis hemorrágica asociada a poliomavirus en 7 casos (5,7 por ciento de los TMO), 6 por BK y 1 por JC. Corresponden <: a 3 varones y 4 mujeres, con una edad media de 29 años (14-45). Todos los pacientes con urocultivos bacteriológicos, micóticos y parasitológicos negativos. Presentación clínica como hematuria macroscópica en todos los casos (aparición entre los días +30 y+132 post-trasplante), cuya duración osciló entre 3 y 30 días. En 6 casos existían criterios de Enfermedad de Injerto Contra Huésped. Eeográficamente, en 5 pacientes se evidenció un engrosamiento difuso de la pared vesical. En todos se instauró tratamiento mediante hiperhidratación, sondaje vesical y extracción de coágulos, lavado endovesical continuo, alcalinización urinaria y antivirales sistémicos. No fueron necesarias actuaciones " más agresivas. Como complicación, un caso de insuficiencia renal leve, reversible.COMENTARIOS: La cistitis hemorrágica por poliomavirus es una entidad que considerar en pacientes que han recibido un T.M. O., debiendo realizar diagnóstico diferencial ante toda hematuria que se presente en estos casos. Es necesario un adecuado manejo urológico de la hematuria, que puede llegar a comprometer la vida del paciente. (AU)

Hematopoyesis extramedular, un simulador de difícil prognóstico / Extramedular hematopoyesis, a difficult diagnosis simulator

La hematopoyesis extramedular es el resultado de la hipofunción severa crónica de la médula ósea, siendo muy infrecuente la presentación en órganos del aparato génito-urinario. Presentamos un caso importante por sus implicaciones clínicopatológicas y rareza en el contexto de un tumor de urotelio alto superficial (AU)

[Primary vaginal lithiasis associated with urethrovaginal fistula. Report of a case and review of the literature]. / Litiasis vaginal primaria asociada a fístula uretrovaginal. Presentación de un caso y revisión de la literatura.

Vaginal stones are rare. We can classify them as primary or secondary, depending on the presence or the absencse of a foreign body nidus. Various cases can led to stone formation. Most of them developed in women with a vesicovaginal or urethrovaginal fistula, as well as in patients with congenital anomalies of the genitourinary tract, previous pelvic radiotherapy, neuropathic bladder and other different causes of vaginal outlet obstruction. Secondary vaginal stones, formed around foreign bodies, are not so frequent. Radiological examination and urethro-vaginoscopy make easy the right diagnosis. Sometimes the stone may be fragmented by lithotripsy before the extraction. The associated etiology should be treated concomitantly in order to prevent recurrence. We report a case of primary vaginal stone associated with an urethrovaginal fistula in a 25 years old women and a review of the related literature.

Tumor renal neuroendocrino. Un caso de rara presentación. Revisión de la literatura / Neuroendocrine renal tumor, a case of exceptional presentation. Review of the literature

Los tumores renales neuroendocrinos son de presentación extremadamente rara. Presentamos un caso clínico y revisamos la literatura sobre esta patología (AU)

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Litiasis vaginal primaria asociada a fístula uretrovaginal. Presentación de un caso y revisión de la literatura / Primary vaginal stones associated to a urethrovaginal fistula. A case presentation and bibliography review

Las litiasis vaginales son poco frecuentes. Se clasifican en primarias o secundarias, en función de la existencia o no de un cuerpo extraño que haya actuado como matriz para la formación del cálculo. Además, varias condiciones pueden contribuir a su desarrollo. La mayoría de los casos están asociados a fístulas vésico-vaginales o uretrovaginales, apareciendo también en casos de malformaciones congénitas genitourinarias, vejigas neurógenas, radioterapia pélvica u otras etiologías que condicionen obstrucción a nivel vulvovaginal. Las debidas a la presencia de un cuerpo extraño son menos frecuentes. Los exámenes radiológicos y la uretrovaginoscopia permiten establecer el diagnóstico. Para su extracción puede ser necesaria la litofragmentación previa. Es necesario corregir al mismo tiempo la etiología subyacente para prevenir las recurrencias. Presentamos un caso de litiasis vaginal asociada a fístula uretrovaginal en una joven de 25 años, y realizamos una revisión de los aspectos más importantes existentes en la literatura (AU)

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[Juvenile gangrenous vasculitis of the scrotum. Report of a new case and review of the literature]. / Vasculitis gangrenosa juvenil del escroto. Aportación de un nuevo caso y revisión de la literatura.

Juvenile gangrenous vasculitis of the scrotum is a peculiar form of scrotal gangrene of undetermined etiology, with clinical and pathological features of its own, described in 1973 by Piñol et al. We report a new case, considering this entity as part of the differential diagnosis of scrotal gangrene, and a review of relative literature.

Vasculitis gangrenosa juvenil del escroto. Aportación de un nuevo caso y revisión de la literatura / Juvenile gangrenous vasculitis of the scrotum. Contribution with a new case and a revision of the literature

La vasculitis juvenil del escroto es una forma peculiar de gangrena escrotal de etiología desconocida y características clínicas y patológicas propias, descrita en 1973 por Piñol y colaboradores. Presentamos un nuevo caso de esta entidad, dentro del diagnóstico diferencial de las gangrenas escrotales y revisamos la literatura existente al respecto (AU)

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[Prostatic mucinous adenocarcinoma. Report of a new case and review of the literature]. / Adenocarcinoma mucinoso de próstata. Presentación de un nuevo caso y revisión de la literatura.

OBJECTIVE: To present an additional case of mucinous adenocarcinoma of the prostate gland. The histochemical and immunohistochemical findings demonstrating its prostatic origin are presented and the literature is reviewed. METHODS/RESULTS: A 53-year-old male with no previous symptoms or signs presented for a prostatic examination. DRE was normal and PSA was 35 ng/ml. A prostate biopsy demonstrated adenocarcinoma of the prostate with a Gleason score of 3 + 3. Complementary studies were negative. The patient was submitted to radical prostatectomy. Anatomopathological analysis of the surgical specimen demonstrated a prostatic mucinous adenocarcinoma. At one-year follow-up, the patient is alive and disease-free and PSA values have returned to normal. CONCLUSIONS: Mucinous adenocarcinoma of the prostate is a rare anatomopathological variant whose natural history and prognosis are not well-known. This tumor type generally does not respond to any treatment and is hormone-resistant.

[Neuroendocrine renal tumor. An unusual case. Review of the literature]. / Tumor renal neuroendocrino. Un caso de rara presentación. Revisión de la literatura.

The neuroendocrine renal tumors are of extremely strange presentation. We present a review of the literature published on this pathology.

[Synchronous tumor of the upper urinary tract with bladder cancer. Opportunity for nephroureterectomy and block-cystectomy]. / Tumor sincrónico de vías altas con cáncer vesical. Oportunidad de nefroureterectomía y cistectomía en bloque.

OBJECTIVE: One of the basic characteristics of urothelial carcinoma is its tendency to synchronous or metachronous multifocality. Thus the need to explore the entire urinary tract of patients with urothelial neoformations. The aim of this article is to study the tumors of the upper urinary tract that appear synchronously with infiltrating carcinoma of the bladder. The clinicopathological characteristics and the morbidity and mortality of en bloc surgery of both tumors are analyzed. METHODS: A retrospective study was carried out on 170 radical cystectomies for infiltrating bladder tumor performed in our department over a 13-year period. Patient history, clinicopathological characteristics, complementary tests, type of surgery performed, postoperative complications and follow-up were analyzed. RESULTS: Tumor of the upper urinary tract appeared in 14 (1 bilateral) of these patients and were synchronous in 10 cases. All patients were male; mean age 63 years. Three were localized in the pelvis, 2 in the proximal ureter and 6 in the distal third. Diagnosis was made by IVP in 6 patients and by US and antegrade pyelography in the other 4 patients. Nephroureterectomy and radical cystectomy were performed en bloc in 8 cases; 6 had a Bricker procedure and 2 ileal substitution. Salvage radical cystectomy + distal ureterectomy were performed in the other two patients. Two patients submitted to en bloc surgery had postoperative complications; one presented prolonged ileua and the other required surgery for retroperitoneal hemorrhage. The two patients submitted to palliative surgery died of and sepsis during the postoperative period. At 33 months' mean follow-up, 3 patients have shown tumor progression. CONCLUSIONS: There is a high proportion of synchronous tumor of the upper urinary tract in our series of patients with infiltrating carcinoma of the bladder undergoing radical cystectomy, therefore we consider it necessary to explore the entire urinary system. Surgical removal of both tumors en bloc does not increase the morbidity and mortality.

[Metastasis priapism. Report of 4 new cases and review of the literature]. / Priapismo metastásico. Presentación de cuatro nuevos casos y revisión de la literatura.

OBJECTIVE: Four additional cases of malignant priapism or priapism secondary to penile metastasis from urogenital tumors are presented and the literature is reviewed. METHODS: Chest and abdominal radiological evaluation, cavernosal and abdominal US, abdominal and pelvic CT and MRI, and cavernosal biopsy were performed for the localization and staging of the primary tumor. RESULTS: Conservative palliative management achieved a survival of only a few months in three of the patients with tumor dissemination to adjacent vital organs. Radical surgery was performed in one patient with tumor localized to the genital area. Currently, this patient has no clinical symptoms, although the follow-up is only 4 months. CONCLUSIONS: Malignant priapism is rare and usually secondary to GU tumors. The prognosis is poor since it generally indicates the presence of multiorgan metastasis. However, the prognosis is better for single metastasis, which is an indication for radical surgery.

[Cystic pyeloureteritis and infection. Presentation forms and review of the literature]. / Pieloureteritis quística e infección. Formas de presentación y revisión de la literatura.

OBJECTIVE: To present three illustrative cases of pyeloureteritis cystica and review the literature. METHODS: Three illustrative cases diagnosed at our department are described. Patient history, clinical features, diagnostic procedures and treatment are analyzed and the literature is reviewed. RESULTS: Our patients had no specific symptoms. All three patients had urinary tract infection with pyeloureteral involvement, which was bilateral in two cases. One of these patients had a long-indwelling catheter. CONCLUSIONS: Pyeloureteritis cystica is a benign and uncommon condition whose etiology is not well-known. It is generally associated with chronic infection and inflammation, and may be difficult to distinguish from other filling defects of the urinary tract. Due to its benign nature, treatment must always be conservative and close follow-up is recommended.

[The management of urinary candidiasis in cystectomized patients]. / Manejo de la candidiasis urinaria en pacientes cistectomizados.

Presentation of eight cases of urinary candidiasis in patients who underwent radical cystectomy and were managed using by-pass of the urinary tract, oral antifungal therapy and solutions in the way of intermittent instillation through nephrostomy catheters.

[AIDS and HIV infections in urologic practice]. / SIDA e infecciones por VIH en la práctica urológica.

The infection caused by the Human Immunodeficiency Virus (HIV), a retrovirus, leads to a progressive decline and to the suppression of cell-mediated immunity favouring the development of opportunistic diseases and potentially fatal neoplasias which are practically innocuous in individuals with an intact immunologic system. The number of AIDS cases recorded in Spain until March 1997 was 45,132, with a revised mortality rate of 58%. Cases in Murcia total 713 up to October 1997, of which 217 patients are being monitored in the AIDS Unit in our centre, 414 individuals have died in the region. It is well know that about one third of patients with diagnosed AIDS or who are HIV carriers will develop some type of genitourinary lesion, either as a result of a renal disorder, concurrent or not with HIV, or any other condition directly related to the infection. This is a report on our Service's experience in the treatment of HIV patients with genitourinary symptoms that, in a total of 15 cases, required our intervention. Emphasis is placed on the incidence of nephrolithiasis secondary to therapy with protease inhibitors over the last few months following introduction of this new therapeutic tool, prostatitis due to salmonella, and inlaid cystitis among others.

[Management of the complications of ureterointestinal reimplantation in urinary diversion]. / Manejo de las complicaciones del reimplante ureterointestinal en las derivaciones urinarias.

OBJECTIVE: To analyze our experience in the management of complications of ureteroenteric reimplantation in patients undergoing urinary diversion by endourological techniques or open surgery, in order to identify a useful algorithm that takes the oncologic prognosis into account, as well as the probability of success. METHODS: A retrospective study was conducted on 136 patients who had undergone urinary diversion from 1987-1998. Of these, 126 had transitional cell carcinoma, two had infiltrating carcinoma, two had a benign condition and 6 had undergone urinary diversion for patient comfort without cystectomy. The following techniques were utilized: cutaneous ureteroileostomy or Bricker technique (104 patients), Mainz neobladder (10 patients), ileal neobladder (15 patients), colonic conduit (5 patients) and cutaneous ureter (2 patients). RESULTS: Overall, 56 patients (41%) had some type of alteration at the ureteroenteric reimplantation site, but only 36 (26%) required intervention. The reimplantation techniques utilized were: the Bricker direct ureteroileostomy (26 patients), Le Duc (6 patients), Leadbetter (3 patients), and the direct cutaneous technique (1 patient). Patient mean age was 67 years (range 53-80). There were 35 males and one female. Seven patients required immediate reimplantation due to a persistent urinary fistula and 29 had late obstruction (more than 3 months), accounting for 21.3% of the cases undergoing urinary diversion. The antegrade endourological approach was utilized in 24 patients (5 nephrostomy alone and 19 stent or balloon dilatation). Dilatation was performed palliatively in 6 cases with extensive tumor spread. Permanent success was achieved in 5 cases (38%) and in spite of the initial success, there were 4 reobstructions. Open surgery was performed in 24 patients (66% of the complicated reimplantations); 5 of these patients had another pathology that warranted laparotomy, 7 required reimplantation early due to a fistula and two patients with a nonfunctioning kidney underwent nephrectomy. Ureteral replacement using the ileum was performed in 4 patients and direct reimplantation to the primary loop was performed in 6 patients. Good surgical results were consistently achieved. CONCLUSIONS: The complication rate of ureteral reimplantation is high in patients undergoing urinary diversion. Endourology has an important role in these cases, particularly in patients with a poor prognosis. Surgery achieves the best results. Although they may entail difficulty, complex cases such as extensive ureteral necrosis can be managed successfully.