Metástasis testicular metacrónica secundaria a adenocarcinoma renal de células claras / Metachronic testicular metastasis secondary to clear cell renal adenocarcinoma

Objetivo: Presentar un caso de metástasis inusual en testículo de origen renal. Método: Paciente de 57 años afecto y en tratamiento por un cáncer renal derecho diseminado que durante su evolución con terapia médica aparecieron metástasis óseas y un nódulo doloroso en polo superior testicular derecho, que obligó a cirugía, con resultado de metástasis de adenocarcinoma de células claras. Resultado: A los 6 meses el paciente sigue en tratamiento con sorafenib oral sin que se hayan manifestado más implantes metastáticos. Conclusiones: Los tumores secundarios metástasicos en testes suponen menos del 1% del total de tumores testiculares. En pacientes en la 5ª y 6ª década, sobre todo afectos de otras neoplasias, las masas testiculares acostumbran a ser implantes metastáticos. El origen más frecuente es el prostático (AU)

Objective: To report one case of unusual testicular metastasis from a renal origin. Methods: 57-year-old patient with disseminated right renal cancer under treatment who presented bone metastasis and a painful nodule in the upper pole of the right testicle during his follow-up with medical therapy, making surgery necessary. The pathology result was clear cell adenocarcinoma. Results: Six months later the patient continues under oral Sorafenib without evidence of new metastatic implants. Conclusions: Testicular secondary metastatic tumors account for less than 1% of old testicular tumors. In patients in the fifth and sixth decades, mainly if they are affected by other neoplasias, testicular masses use to be metastatic implants. The most frequent origin is prostate (AU)

Angiomiolipoma epiteloide renal / Epithelioid renal angiomyolipoma

Objetivo: Poner de manifiesto la existencia de una variedad de angiomiolipoma, denominada epitelioide, con propiedades diferentes tanto histológicas como clínicas. Método: Se presenta el caso de una mujer de 17 años, afecta de enfermedad de Bourneville, a la que en un control tomográfico renal se descubre la existencia de una masa sólida sugestiva de carcinoma, adyacente a otras de menor tamaño identificadas como angiomiolipomas. Resultados: Tras realizar varias tumorectomías, la sospechosa de carcinoma, de 4 cm de tamaño se diagnostica de angiomiolipoma epitelioide, con corroboración inmunohistoquímica mediante positividad para HMB45, y negatividad a vimentina y queratina. Conclusiones: A pesar de la posibilidad de coexistencia de adenocarcinoma y angiomiolipomas, no hay que descartar la existencia de la variedad epitelioide, sobre todo en pacientes con facomatosis. Los criterios quirúrgicos serán los mismos que para el resto de masas renales. Sin embargo, los criterios de seguimiento deberán ser más estrictos dada la posible evolución tórpida en cuanto a diseminación de esta infrecuente variedad de angiomilipoma (AU)

Objective: To issue the existence of a variety of angiomyolipoma, named epithelioid, with different histological and clinic properties. Methods: We report the case of a 17-year-old female, with Bourneville’s disease, who was discovered to have a solid renal mass suggestive of carcinoma in a control CT scan, adjacent to other smaller masses identified as angiomyolipomas. Results: After several tumorectomies, the suspicious mass, 4 cm in size, was diagnosed as epithelioid angiomyolipoma, with immunohistochemical confirmation of capacity for HMB45, and negative vimentin and keratin. Conclusions: Despite the possibility of coexistence of adenocarcinoma and angiomyolipoma, the existence of an epithelioid variety cannot be discarded, mainly in patients with phakomatosis. The indications for surgery are the same than for the rest of renal masses. Nevertheless, follow-up criteria must be stricter due to the possibility of torpid outcome in terms of dissemination of this infrequent variety of angiomyolipoma (AU)

[Scrotal liposarcoma]. / Liposarcoma escrotal.

OBJECTIVE: To describe an additional case of scrotal liposarcoma and its treatment, which was distinct from conventional treatment. METHODS: The literature on paratesticular masses is reviewed with special reference to the liposarcomas. An additional case of liposarcoma is described which was treated by tumor excision without involvement of the testis. The diagnosis, classification and treatment of this condition are discussed. RESULTS: Liposarcoma is a very uncommon tumor and its diagnosis is based on the anatomopathological findings. Treatment is by orchidectomy with high ligation of the spermatic cord. However, the case described herein was treated only by resection of the tumor. Radiotherapy may be indicated in some cases. Chemotherapy does not appear to be useful in this type of tumor. CONCLUSION: In some cases of scrotal liposarcoma, the tumor can be resected without performing orchidectomy.

[Retroperitoneal liposarcoma in a patient with renal transplantation]. / Liposarcoma retroperitoneal en un paciente trasplantado renal.

A case of retroperitoneal sarcoma in a kidney transplanted patient is presented. We describe the presentation pattern and the aggressive outcome despite the surgical removal of 5.900 gr. retroperitoneal tumor, included native kidney. The patient died due multiple metastasis six months later. An interesting iconography shows the great volume of the tumor.

[Pelvic lipomatosis: contribution of a new case to the literature]. / Lipomatosis pelviana: aportación de un nuevo caso a la literatura.

OBJECTIVE: To describe an additional case of pelvic lipomatosis, a rare condition that can be encountered by the urologist. METHODS/RESULTS: A 66-year-old patient consulted for irritative voiding syndrome and fever. Patient evaluation by IVP and CT demonstrated pelvic lipomatosis. CONCLUSIONS: Pelvic lipomatosis is a disease with variable clinical and radiological features. Careful follow-up is warranted for prevention and treatment of possible complications.

Liposarcoma retroperitoneal en un paciente trasplantado renal / Retroperitoneal sarcoma in a kidney trasplanted patient

Presentamos un caso de liposarcoma retroperitoneal en un paciente trasplantado renal. Describimos la forma de presentación, y su evolución clínica, que fue particularmente agresiva tras la intervención quirúrgica, en la que se extirpó una masa retroperitoneal de 5.900 gramos que incluía riñón propio. El paciente falleció 6 meses después de la intervención por múltiples metástasis sistémicas. Asimismo mostramos una iconografía interesante por el volumen que alcanzó la masa hasta hacerse clínicamente evidente (AU)

[Renal carcinoma with vena cava invasion. A new case]. / Carcinoma renal con invasión de vena cava. Un nuevo caso.

It is well known that the renal carcinoma can progress to the renal vein and cava. The MRI is the most accurate study in order to assay the extension of the thrombus. The surgical management is based on the extension and location of the thrombus. New immunologic-based treatment is now being tested. We describe our experience with surgical management of the one case of renal carcinoma with cava vein thrombus. No evidence of progression is noted after 18 month follow up.

Carcinoma renal con invasión de vena cava. Un nuevo caso / Renal carcinoma with vena cava invasion. A case report

El tumor de células renales presenta una intensa predisposición a crecer hacia la vena renal y vena cava. Cuando existe trombo tumoral en la vena cava es fundamental delimitar su extensión, y para ello contamos con la R.M.N. como la exploración más precisa. La vía de acceso quirúrgico y la técnica utilizada para la exéresis viene radicalmente determinada por la localización y extensión del tumor. En los últimos años se ha abierto una nueva esperanza terapéutica con los tratamientos de base inmunológica. Presentamos un caso de tumor de células renales con trombo en la vena cava tratado quirúrgicamente, y con un seguimiento de 18 meses, sin evidencia de recidiva ni extensión a distancia (AU)

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[Sarcomatoid renal carcinoma]. / Carcinoma renal sarcomatoide.

OBJECTIVE: Sarcomatoid carcinoma of the kidney is a unique, uncommon variety of parenchymatous tumors and is considered to have a worse prognosis by stage than the other histological types. Our experience is reviewed and compared with the larger series reported in the literature. METHODS: Of 101 cases of renal carcinoma submitted to surgery at our department from January, 1990 to December, 1996, there were 4 cases of sarcomatoid carcinoma of the kidney. We compared our cases with the larger series (91 cases in total) reported in the literature for incidence, age, distribution according to sex, tumor size, location, form of presentation, stage and survival. RESULTS: Sarcomatoid renal carcinoma accounts for 1% to 6% of parenchymatous tumors of the kidney according to the different series. The mean age at presentation was 48 years (range 27-61) in our series; there was no prevalence according to sex or location; the renal capsule was not compromised in 3 out of the 4 cases; only one case showed regional lymph node involvement and no case showed distant metastasis at the time of diagnosis. Although these tumors are diagnosed in the advanced stages, two of our cases were incidentally discovered in the early stages (one died 13 months thereafter and the other is alive at 42 months). Patients that are alive and disease-free can only be found in the patient group with stage I or II tumor. All patients with tumor stage III and IV have died. This histological type has a worse prognosis. Most of the series report a mean survival of 5 months. CONCLUSIONS: Sarcomatoid renal carcinoma accounts for 1%-6% of all renal carcinomas. It can present at any age and has a very poor prognosis, with a mean survival of 6 months.

[Albuginea plication in the treatment of penile curvature]. / Plicatura de la albugínea como tratamiento para la incurvación de pene.

Presentation of the results obtained by our team in the treatment of 22 cases of penial incurvation (11 congenital and 11 secondary to Peyronie's Disease) using the albuginea plication technique. Evaluation of post-operative results taking into account both subjective (extent of satisfaction, comfort during the post-operative etc.) and objective (post-operative complications, degree of correction, reincurvation or failure etc.) factors was done by a follow-up programme through the out-patients practices using a Questionnaire-Survey system. Presentation of results obtained and detailed discussion of each case. The conclusions were as follows: Albuginea plication is a safe technique that achieves total penis redressment, with no post-operative complications. The extent of satisfaction and success obtained exceed 85%, and can be increased by improving the pre-operative selection and providing correct and precise information on what can be resolved with this technique.

[Relation between renal transplantation and work situation]. / Relación entre trasplante renal y situación laboral.

OBJECTIVE: The present study analyzed occupational rehabilitation following renal transplantation and its impact on social costs. METHODS/RESULTS: A survey was conducted on 493 patients who had undergone renal transplantation during 1979 to 1995. The results show that 27.76% were working after kidney transplantation versus 27.52% during dialysis. Retirement was the most common explanation given for not working (29.4%) when the percentage of those over age 65 accounted for 8%. CONCLUSION: Analysis of the occupational status in relation with sex, age, level of education, profession and type of dialysis disclosed that women aged 25-34 years, with a high level of education, who describe themselves as entrepreneurs and have had peritoneal dialysis, have a higher likelihood of working after transplantation.

[Vasitis nodosa]. / Vasitis nodosa.

OBJECTIVE: To describe a case of vasitis nodosum causing spontaneous recanalization of the vas deferens. METHODS: Herein we describe a patient who had undergone vasectomy 9 years earlier. A nodule in the vas deferens arising from granulomatous reaction had progressed to vasitis nodosum, causing spontaneous recanalization of the vas deferens. RESULTS: Vasitis nodosum may be more frequent than it is considered to be although clinical problems rarely arise. CONCLUSION: Confusion may arise in distinguishing the histological features of vasitis nodosum from those of adenocarcinomatous neoplasia. Although rarely, its growth may cause recanalization of the vas deferens in vasectomized patients.

[Extragonadal germinal tumor]. / Tumor germinal extragonadal.

OBJECTIVE: Extragondal germ cell tumors are rare and have a high affinity for the midline structures. Herein we describe a young, male patient with a retroperitoneal primary tumor. METHODS/RESULTS: The unorthodox form of presentation of germ cell tumors corroborates their embryologic gonadal origin which is distant from the site of presentation. CONCLUSION: The diagnostic algorithm, chemotherapeutic and surgical treatment guidelines utilized in the management of primary gonadal germ cell tumors with retroperitoneal involvement remain applicable in this rare form of presentation.

[Paratesticular adenomatoid tumor]. / Tumor adenomatoide paratesticular.

OBJECTIVE: To report a case of paratesticular tumor involving the right testis. METHODS/RESULTS: A middle-aged male with a small paratesticular tumor involving the right testis is described. Treatment was by transscrotal surgical excision. The histological analysis of the surgical specimen disclosed a mesothelial tumor and no evidence of malignancy. CONCLUSION: Although the preoperative diagnosis of adenomatoid tumor is relatively simple when the epididymis is involved, localization in the testis is relatively difficult to determine. Surgical exploration of all intrascrotal and intratesticular tumors are advocated due to the risk of malignancy.

[Sexual changes in men with urological disorders]. / Alteraciones sexuales en varones con trastornos urológicos.

OBJECTIVE: To evaluate the changes in sexual function due to urological pathologies and their treatment in the male. The present study analyzed erection, ejaculation, frequency of sexual intercourse and orgasm. METHODS: A questionnaire comprised of 30 items were sent out to 1016 males over 18 years of age with urological disease that had been treated from 1990 to 1991. Data processing was carried out using the Statgraphics and Statistica programs. The x2 and Wilcoxon Z tests were utilized for statistical analysis. RESULTS: All of the parameters studied were found to be impaired in a high number of patients in relation to age, pathology and treatment. Benign prostatic hyperplasia and its treatment caused the most impairment. CONCLUSIONS: Erection, ejaculation, frequency of sexual intercourse and orgasm decreased significantly after a urological condition. In our view, patient preoperative data and analysis of the foregoing parameters are warranted.

[Socioeconomic justification of kidney transplantation]. / Justificación socioeconómica del trasplante renal.

OBJECTIVES: In recent years, the socioeconomic aspects of renal transplantation have focused the attention of the managers of the health care system and the professionals involved in transplant programs. The present study analyzed, within the context of renal transplantation, the two fundamental concepts of health care: quality of life and health costs. METHODS: A survey was conducted in 427 patients who underwent renal transplantation to evaluate the improvement in their quality of life. RESULTS: 93% referred physical improvement, 85% emotional, and 85% subjective improvement in their family relationship. Considering 9% of the kidneys were not viable, 15% of the grafts were lost in the first year and 4% thereafter, the cost of transplantation for the first year (in million pesetas) was 3,597 versus 2,961 for hemodialysis and 905 for the second year, with hemodialysis costs practically unchanged. CONCLUSIONS: Renal transplantation not only increases survival but also improves quality of life. It is less costly and the savings in health costs can be allocated to other fields of health care.

[Pararenal angiomyolipoma]. / Angiomiolipoma pararrenal.

OBJECTIVES: To review the more relevant clinical aspects of extrarenal angiomyolipoma, an uncommon disease entity. METHODS: The patient was a middle-aged female in whom an irregular right extrarenal mass had been detected. The pathological analysis disclosed a hamartoma. RESULTS: Complete resection of this lesion achieved cure. METHODS: Angiomyolipoma is a benign tumor that generally involves one or both kidneys. Extrarenal angiomyolipoma is extremely uncommon and may warrant the use of diagnostic tools distinct from the widespread algorithm and may require aggressive maneuvers to make the correct diagnosis.

[Non-instrumental traumatism of the urethra: our experience]. / Traumatismos no instrumentales de la uretra: nuestra experiencia.

OBJECTIVES: To report our experience in the diagnosis and treatment of this type of urologic trauma. The results are analyzed in order to determine the best therapeutic approach and the literature reviewed. METHODS: The series comprised 9 males; 6 had rupture of the posterior urethra and 3 had anterior urethral trauma. Four cases underwent suprapubic drainage and delayed definitive treatment; early realignment of the urethra was performed in 3 cases, and the only patient with a penetrating injury immediately underwent a repair procedure. Urethral urethrotomy sufficed in one patient with partial rupture of the anterior urethra. Delayed treatment consisted of end-to-end anastomosis; one patient required pubic partial resection. RESULTS: Good results were achieved by end-to-end anastomosis; 3 patients have been discharged and one required internal urethrotomy. Two of these patients have remained impotent. The patients submitted to early realignment of the urethra are managed well with regular dilatation and internal urethrotomy in some cases. CONCLUSIONS: We found suprapubic drainage and delayed repair superior to early realignment in those cases with posterior urethral injury. In our view, delayed end-to-end anastomosis, with or without pubic resection can be performed in virtually all cases. We advocate immediate repair of penetrating injuries to the anterior urethra.

[Vascular testicular tumors]. / Tumores vasculares testiculares.

OBJECTIVES: The present study reviews vascular testicular tumors, a very rare pathology. To our knowledge, only 17 cases have been reported since 1921. METHODS/RESULTS: We describe a case of a 16-year-old male who consulted for a mass of sudden onset. Pathological examination disclosed a testicular angioma. CONCLUSIONS: Despite the advancements of the imaging techniques, there are no signs that indicate the nature of vascular testicular neoplasms. The good prognosis of these tumors underscores the importance of the anatomopathological differential diagnosis.