Leiomyosarcoma of the kidney: case report.

BACKGROUND: Renal sarcomas represent 1-2% of malignant kidney tumors in adults; 50% of renal sarcomas are composed of leiomyosarcomas. These tumors generally arise from the renal capsule, smooth muscle tissue of the renal pelvis and intrarenal vessels. They are indistinguishable from other renal masses prior to surgery and are associated with an adverse prognosis. CLINICAL CASE: We report the case of a 58-year-old female with a clinical course characterized by asthenia, weakness, generalized attack to her health status and pain in the left renal fossa. Computed axial tomography was performed where a left retroperitoneal tumor was diagnosed. Left radical nephrectomy was performed. The histopathology report demonstrated leiomyosarcoma originating from the renal sinus vessels. The patient was successfully treated with adjuvant radiotherapy. CONCLUSIONS: Renal leiomyosarcomas usually have an aggressive biological behavior with poor prognosis, accounting for surgical treatment with wide resection associated with adjuvant chemotherapy and radiotherapy as the only therapeutic option.

[Androgen-deprivation therapy in the management of neuroendocrine prostate cancer].

BACKGROUND: Prostatic neuroendocrine carcinomas comprise <1% of all prostate neoplasms, and approximately 200 cases have been reported in the literature. We undertook this study to describe the experience in the management of prostatic neuroendocrine carcinoma with androgen-deprivation therapy (ADT). METHODS: We designed a retrospective, descriptive and observational study. In patients with suspicion of prostate cancer, transrectal ultrasonography-guided biopsy (TRUS) or transurethral resection of prostate (TURP) was carried out during the period from January 2000 to December 2007. Patients were selected by anatomopathological diagnostic study of neuroendocrine carcinoma including pure and mixed variants. Characteristics analyzed were age, clinical stage, prostate-specific antigen (PSA), imaging studies, treatment and survival. RESULTS: Ten cases were included with a median age of 66.5 years. Symptoms at diagnosis were associated with metastasis to other organs, one with bone metastasis, and presenting pain in 100% of the cases. A suspicious rectal digital examination was detected in 100% of the patients. In three (30%) patients, PSA was suspicious for prostate cancer. The extension studies showed bone, locoregional, lung and hepatic metastases. In six (60%) patients mixed variant was documented (acinar adenocarcinoma and neuroendocrine carcinoma) with a median survival of 11.6 months. In four patients (40%), pure neuroendocrine carcinoma was documented with a median survival of 7 months. CONCLUSIONS: Prostatic neuroendocrine carcinoma is uncommon, aggressive and represents a prostatic neoplasia without PSA expression. In advanced disease, very low response is reached with ADT.

Bloqueo androgénico total en el manejo del cáncer de próstata neuroendocrino / Androgen-deprivation therapy in the management of neuroendocrine prostate cancer

Introducción: El carcinoma prostático neuroendocrino constituye menos de 1 % de las neoplasias prostáticas, con menos de 200 casos en la literatura. El objetivo de esta investigación fue describir la experiencia en el manejo del carcinoma neuroendocrino de próstata con bloqueo androgénico total. Material y métodos: Estudio retrospectivo, descriptivo y observacional, en el que se revisaron los expedientes de pacientes con sospecha de cáncer de próstata sometidos a biopsia transrectal o resección transuretral de próstata, de enero de 2000 a diciembre de 2007. Fueron seleccionados pacientes con diagnóstico anatomopatológico de carcinoma neuroendocrino en sus variantes pura y mixta. Se analizó edad, estadio clínico, antígeno prostático específico, estudios de gabinete, tratamiento y sobrevida. Resultados: Se incluyeron 10 casos con edad media de 66.5 años; los síntomas al momento del diagnóstico estaban asociados a invasión metastásica a distancia, siendo el principal el dolor óseo. Se identificó un tacto sospechoso en todos los pacientes y solo en tres (30 %) el antígeno prostático específico fue sospechoso de cáncer. Los estudios de extensión determinaron actividad metastásica ósea, locorregional, pulmonar y hepática. En seis (60 %) se documentó la variante mixta (adenocarcinoma acinar más carcinoma neuroendocrino), con una sobrevida promedio de 11.6 meses, y en cuatro (40 %) se registró carcinoma neuroendocrino puro, con una sobrevida promedio de siete meses. Conclusiones: El carcinoma neuroendocrino de próstata es infrecuente, agresivo y un ejemplo de neoplasia prostática que no expresa el antígeno prostático específico, con mala respuesta al bloqueo androgénico total en etapa avanzada.

BACKGROUND: Prostatic neuroendocrine carcinomas comprise <1% of all prostate neoplasms, and approximately 200 cases have been reported in the literature. We undertook this study to describe the experience in the management of prostatic neuroendocrine carcinoma with androgen-deprivation therapy (ADT). METHODS: We designed a retrospective, descriptive and observational study. In patients with suspicion of prostate cancer, transrectal ultrasonography-guided biopsy (TRUS) or transurethral resection of prostate (TURP) was carried out during the period from January 2000 to December 2007. Patients were selected by anatomopathological diagnostic study of neuroendocrine carcinoma including pure and mixed variants. Characteristics analyzed were age, clinical stage, prostate-specific antigen (PSA), imaging studies, treatment and survival. RESULTS: Ten cases were included with a median age of 66.5 years. Symptoms at diagnosis were associated with metastasis to other organs, one with bone metastasis, and presenting pain in 100% of the cases. A suspicious rectal digital examination was detected in 100% of the patients. In three (30%) patients, PSA was suspicious for prostate cancer. The extension studies showed bone, locoregional, lung and hepatic metastases. In six (60%) patients mixed variant was documented (acinar adenocarcinoma and neuroendocrine carcinoma) with a median survival of 11.6 months. In four patients (40%), pure neuroendocrine carcinoma was documented with a median survival of 7 months. CONCLUSIONS: Prostatic neuroendocrine carcinoma is uncommon, aggressive and represents a prostatic neoplasia without PSA expression. In advanced disease, very low response is reached with ADT.