Solifenacina: evidencia científica en el tratamiento de la vejiga hiperactiva / Solifenacin: Scientific evidence in the treatment of overative bladder

OBJETIVO: En este artículo se pretende analizar el uso de solifenacina en el tratamiento de la vejiga hiperactiva para objetivar su eficacia y seguridad dentro del marco de la evidencia científica.MÉTODOS: Se ha revisado la literatura científica disponible incluyendo la mayoría de los ensayos clínicos relevantes realizados con solifenacina.RESULTADOS: En todos los estudios analizados se aprecian mejorías significativas en los pacientes tratados con solifenacina respecto al placebo y tolterodina. Los parámetros de eficacia han sido valorados en términos objetivos y subjetivos, haciendo hincapié en la calidad de vida. El 60% de los pacientes mejoran su urgencia (40% no reportan urgencia), el 58% recuperan la continencia y el 69% perciben mejoría en su condición vesical. Tras finalizar el tratamiento el 80% se encuentran satisfechos con los resultados y el 79% están dispuestos a continuarlo a largo plazo.CONCLUSIONES: La solifenacina es eficaz en el tratamiento de la vejiga hiperactiva. La posibilidad de encontrar la dosis más eficaz, tolerable y con mejor respuesta en términos de calidad de vida supone una diferencia importante respecto a otros antimuscarínicos. El aumento a 10 mg supone mejorías adicionales en cuanto a eficacia sin suponer un aumento significativo en los efectos adversos. Los efectos secundarios percibidos fueron leves o moderados en la mayoría de los casos, no suponiendo más abandonos de tratamiento que en el grupo de placebo. La mayoría de pacientes se sienten conformes con el tratamiento y están dispuestos a prolongarlo en el tiempo(AU)

OBJECTIVES: This article aims to analyse the use of solifenacin in the treatment of overactive bladder in order to show its efficacy and safety within the framework of the scientific evidence.METHODS: The available scientific literature was reviewed, including most of the relevant clinical trials performed with solifenacin.RESULTS: All the studies analysed show significant improvements in patients treated with solifenacin versus placebo and tolterodine. Efficacy parameters were assessed in objective and subjective terms, with particular emphasis placed on quality of life. Urgency improves in 60% of patients (40% report no urgency), 58% of patients get continence and 69% perceive an improvement in bladder condition. On completion of treatment, 80% are satisfied with the results and 79% are willing to continue with the treatment in the long term.CONCLUSIONS: Solifenacin is efficacious in the treatment of overactive bladder. The possibility of finding the most effective and tolerable dose with the best response in terms of quality of life constitutes an important difference with regard to other antimuscarinics. The increase to 10 mg gets additional improvements in terms of efficacy, without a significant increase in adverse effects. The side effects perceived were mild or moderate in most cases, and did not lead to more withdrawals compared to placebo. Most patients were satisfied with the treatment and are willing to stay on it in the long term(AU)

[Soft tissue metastases by micropapillary bladder carcinoma. Metastatic disease]. / Metástasis en partes blandas por un carcinoma micropapilar de vejiga.

Micropapillary transitional cell carcinoma is a rare (incidence of 0.7%) and highly aggressive variant of bladder carcinoma. Morphologically, it is characterized by small tight clusters of neoplastic cell floating in clear spaces resembling lymphatic channels. Its usual presentation is like a high grade and stage carcinoma and most often is associated with a variable component of conventional carcinoma or other variants. The usual sites of bladder cancer metastases are the lymph nodes, lungs, bone and liver. Soft tissues metastases from transitional cell carcinoma of the bladder occur infrequently. We report the cases of a 77-year-old man presenting with an abdominal soft tissue mass a six years after local excision of a micropapillary bladder carcinoma.

Metástasis en partes blandas por un carcinoma micropapilar de vejiga / Soft tissue metastases by micropapillary bladder carcinoma. Metastatic disease

El carcinoma micropapilar es una variante infrecuente de carcinoma vesical (incidencia del 0.7%) con comportamiento clínico agresivo. Histológicamente está constituido por nidos pequeños de células uroteliales dispuestas en lagunas que simulan invasión vascular y se suelen asociar a estadios clínicos avanzados y alto grado histológico. Estos tumores generalmente se asocian a otras variantes histológicas de carcinoma transicional. Los tumores de vejiga suelen metastatizar a ganglios linfáticos, pulmón, hueso e hígado, pero son excepcionales las metástasis a partes blandas. Presentamos el caso de un varón de 77 años que presentó una masa metástasica en partes blandas de pared abdominal a los 6 años de realizarle resección de un carcinoma transicional variante micropapilar de vejiga

Micropapillary transitional cell carcinoma is a rare (incidence of 0.7%) and highly aggressive variant of bladder carcinoma. Morphologically, it is characterized by small tight clusters of neoplastic cell floating in clear spaces resembling lymphatic channels. Its usual presentation is like a high grade and stage carcinoma and most often is associated with a variable component of conventional carcinoma or other variants. The usual sites of bladder cancer metastases are the lymph nodes, lungs, bone and liver. Soft tissues metastases from transitional cell carcinoma of the bladder occur infrequently. We report the cases of a 77-year-old man presenting with an abdominal soft tissue mass a six years after local excision of a micropapillary bladder carcinoma

[Laparoscopic ureterolithotomy of an iliac ureteral stone forgotten for more than eight years]. / Ureterolitotomia laparoscópica de un cálculo de uréter iliaco olvidado durante más de ocho años.

INTRODUCTION: Laparoscopic ureterolithotomy recently rises as a new option in the treatment of ureteral calculi, particularly those of the greatest size, hardness or impactation. We describe such an indication to resolve a case of forgotten for more than eight years and severely obstructive ureteral stone. PATIENT AND METHOD: A 64 years-old male received extracorporeal shock wave lithotripsy for a right distal ureteral stone and, simultaneously, a left impacted iliac ureteral calculi was discovered, at the confluence of an incomplete duplication of the ureter, for which treatment was recommended, but deferred by the patient. Eight years after, the same stone caused a massive dilatation with poor function of the upper pole moiety and slightly preserved function of the lower pole moiety of the left kidney. Two intents of retrograde ureteroscopy failed because of impossibility to reach the stone. Transperitoneal laparoscopic ureterolithotomy was performed in lateral decubitus position, with double J in place and three 10 mm ports. After identification of the dilated ureter, an V-shape ureterothomy was made and the stone mobilized and extracted. The ureter was stented and the ureterothomy closed with intracorporeal suture. The patient had a postoperative stage of four days and a mild functional recovery. DISCUSSION: If the usual treatment options (extracorporeal lithotripsy and ureteroscopy with intracorporeal lithotripsy) failed, then laparoscopic ureterolithotomy is less invasive than open ureterolithotomy. However, the indications of laparoscopic ureterolithotomy are restricted because substantial laparoscopic experience is needed to cope with possible technical difficulties.

[Verrucous carcinoma of the penis arising from a lichen planus. A true preneoplastic lesion?]. / Carcinoma verrucoso de pene desarrollado sobre un liquen plano. Una auténtica lesión preneoplásica?

INTRODUCTION: Up to 30% of squamous cell carcinomas of the penis arise from a lichen sclerosus, but very few reports in which lichen planus was the preexisting lesion have been published. We report a male with verrucous carcinoma of penis that developed in an area of lichen planus. CLINICAL CASE: A 53-year-old male presented with an exophytic tumor on the glans penis that had been present for about 6 months. The lesion developed in a previously biopsied area of lichen planus hypertrophicus. After excision, histological diagnosis was verrucous carcinoma. COMMENT: The development of any subtype of squamous cell carcinoma of penis in a lichen planus can be coincidental, or a neoplastic transformation of lichen planus can take place.

Ureterolitotomia laparoscópica de un cálculo de uréter iliaco olvidado durante más de ocho años / Laparoscopic ureterolithotomy of an iliac ureteral stone forgotten for more than eight years

Introducción: La ureterolitotomía laparoscópica ha surgido recientemente como una nueva opción de tratamiento de los cálculos ureterales de tamaño, dureza o impactación particularmente grandes. Mostramos una indicación de ureterolitotomia laparoscópica para resolver un caso de litiasis olvidada y gravemente obstructiva. Paciente y técnica: Un varón de 64 años fue tratado mediante litotricia extracorpórea de un cálculo de uréter distal derecho, y se le encontró simultáneamente un cálculo impactado en uréter iliaco izquierdo, en la confluencia de una duplicidad ureteral incompleta, cuyo tratamiento prefirió posponer. Ocho años después, el mismo cálculo causaba una masiva dilatación, con mala función del pielón superior y función conservada en el pielón inferior de ese riñón. En dos intentos de ureteroscopia retrógrada resultó imposible alcanzar el cálculo. Se realizó ureterolitotomía laparoscópica transperitoneal, con un catéter doble J en posición y con tres accesos de 10 mm. Se identificó el uréter muy dilatado y mediante una ureterotomía en V, se movilizó y extrajo el cálculo. Se dejó intubado el uréter y se cerró la ureterotomía con puntos intracorpóreos. La estancia postoperatoria fue muy corta y la recuperación funcional se consideró satisfactoria. Discusión: Si las opciones de tratamiento habitual (litotricia extracorpórea y ureteroscopia con litotricia intracorpórea) han fracasado, la ureterolitotomía laparoscópica es una opción menos invasiva que la ureterolitotomía abierta. Sus indicaciones son muy restringidas, pues las posibles dificultades de la técnica exigen una considerable experiencia laparoscópica

Introduction: Laparoscopic ureterolithotomy recently rises as a new option in the treatment of ureteral calculi, particularly those of the greatest size, hardness or impactation. We describe such an indication to resolve a case of forgotten for more than eight years and severely obstructive ureteral stone. Patient and method: A 64 years-old male received extracorporeal shock wave lithotripsy for a right distal ureteral stone and, simultaneously, a left impacted iliac ureteral calculi was discovered, at the confluence of an incomplete duplication of the ureter, for which treatment was recommended, but deferred by the patient. Eight years after, the same stone caused a massive dilatation with poor function of the upper pole moiety and slightly preserved function of the lower pole moiety of the left kidney. Two intents of retrograde ureteroscopy failed because of impossibility to reach the stone. Transperitoneal laparoscopic ureterolithotomy was performed in lateral decubitus position, with double J in place and three 10 mm ports. After identification of the dilated ureter, an V-shape ureterothomy was made and the stone mobilized and extracted. The ureter was stented and the ureterothomy closed with intracorporeal suture. The patient had a postoperative stage of four days and a mild functional recovery. Discussion: If the usual treatment options (extracorporeal lithotripsy and ureteroscopy with intracorporeal lithotripsy) failed, then laparoscopic ureterolithotomy is less invasive than open ureterolithotomy. However, the indications of laparoscopic ureterolithotomy are restricted because substantial laparoscopic experience is needed to cope with possible technical difficulties

Carcinoma verrucoso de pene desarrollado sobre un liquen plano. ¿una auténtica lesión preneoplásica? / Verrucous carcinoma of the penis arising from a lichen planus. A true preneoplastic lesion?

Introducción: Hasta un 30% de carcinomas epidermoides de pene se desarrollan sobre un liquen escleroso, mientras que hay muy pocos casos publicados en los que la lesión preexistente sea un liquen plano. Se presenta un carcinoma verrucoso de pene desarrollado sobre un área de liquen plano. Caso clínico: Un varón de 53 años consultó por presentar un tumor exofítico en glande de 6 meses de evolución, que había crecido sobre una lesión biopsiada 2 años antes, y diagnosticada como liquen plano hipertrófico. Tras su extirpación, el diagnóstico histológico fue de carcinoma verrucoso. Comentario: el desarrollo de cualquier variante de carcinoma epidermoide de pene sobre un liquen plano puede ser meramente casual, o por el contrario podría ser una transformación neoplásica del mismo

Introduction: up to 30% of squamous cell carcinomas of the penis arise from a lichen sclerosus, but very few reports in which lichen planus was the preexisting lesion have been published. We report a male with verrucous carcinoma of penis that developed in an area of lichen planus. Clinical case: a 53-year-old male presented with an exophytic tumor on the glans penis that had been present for about 6 months. The lesion developed in a previously biopsied area of lichen planus hypertrophicus. After excision, histological diagnosis was verrucous carcinoma. Comment: the development of any subtype of squamous cell carcinoma of penis in a lichen planus can be coincidental, or a neoplastic transformation of lichen planus can take place

La posición supine de Valdivia como major opción para la cirugía percutánea de los cálculos renales en el paciente con obesidad mórbida / Valdivia supine position as the best option for percutaneous surgery of renal calculi in morbidly obese patients

Introducción: El tratamiento del paciente obeso grave afecto de cálculos renales sintomáticos, supone un interesante reto urológico. El tratamiento mediante litotricia extracorpórea con frecuencia no es posible por diversas razones, y en algunos centros estos pacientes constituyen una de las indicaciones residuales de cirugía abierta de los cálculos. Material y método: Dos mujeres con índice de masa corporal mayor de 50 kg/m2, afectas de cálculos renales sintomáticos, fueron tratadas mediante nefrolitotomía percutánea bajo anestesia en la posición de Valdivia (decúbito supino ligeramente lateralizado). Se usaron los instrumentos estándar y el ureteroscopio semi-rígido, a través de una vaina de Amplatz proximalmente transfixiada con una sutura de polipropileno para evitar su pérdida bajo la piel. Ambas pacientes quedaron libres de cálculos sin morbilidad significativa. Discusión: Las ventajas de la posición de Valdivia en este tipo de pacientes son claras, tanto para la comodidad del equipo quirúrgico, pues se puede prescindir de la ayuda y del tiempo necesario para voltear al paciente anestesiado a la posición de prono, como para el discurrir de la anestesia, pues son bien conocidas las restricciones cardio-respiratorias creadas por una anestesia general en prono, que son más graves en el paciente obeso. Esta posición nos parece más cómoda que otras recomendadas para la nefrolitotomía percutánea en el paciente obeso, como son el decúbito prono en una mesa de cirugía del raquis, o la posición de decúbito lateral, que puede comprometer el control radiológico de la intervención (AU)

Introduction: Treatment of the morbidly obese patient with symptomatic renal calculi is an interesting urological challenge. Extracorporeal shock wave lithotripsy is frequently not possible for several reasons, and many urological centers match these patients as one of the residual indications for open surgery of kidney lithiasis. Material and method: Two patients with body mass index more than 50 k/m2 and symptomatic kidney stones were treated with percutaneous nephrolithotomy in the supine position described by Valdivia (slightly lateralized supine decubitus). Standard instrumentation for percutaneous surgery and the semi-rigid ureteroscopy were used, through an Amplatz sheath proximally transfixed with a polypropylene stitch, so to avoid its lost under the fatty skin. Both patients were rendered stone-free without significant morbidity. Discussion: The advantages of Valdivia position in those patients are clear, both for the commodity of the surgical team, -because time may be spared and help needed to mobilized the patient is less-, as well as for what concerns to the anesthesia, because cardio-respiratory restrictions created by a general anesthesia in prone are greater and more severe in the obese patient. This position seems to be more suitable than other ones recommended for percutaneous nephrolithotomy in the obese patients, such as prone decubitus on a surgical saddle, or lateral decubitus position, that may compromise the radiological control of the operation (AU)

Laparoscopia en la fibrosis retroperitoneal / Laparoscopy in retroperitoneal fibrosis

No disponible

[Valdivia supine position as the best option for percutaneous surgery of renal calculi in morbidly obese patients]. / La posición supina de Valdivia como mejor opción para la cirugía percutánea de los cálculos renales en el paciente con obesidad mórbida.

INTRODUCTION: Treatment of the morbidly obese patient with symptomatic renal calculi is an interesting urological challenge. Extracorporeal shock wave lithotripsy is frequently not possible for several reasons, and many urological centers match these patients as one of the residual indications for open surgery of kidney lithiasis. MATERIAL AND METHOD: Two patients with body mass index more than 50 k/m2 and symptomatic kidney stones were treated with percutaneous nephrolithotomy in the supine position described by Valdivia (slightly lateralized supine decubitus). Standard instrumentation for percutaneous surgery and the semi-rigid ureteroscopy were used, through an Amplatz sheath proximally transfixed with a polypropylene stitch, so to avoid its lost under the fatty skin. Both patients were rendered stone-free without significant morbidity. DISCUSSION: The advantages of Valdivia position in those patients are clear, both for the commodity of the surgical team, -because time may be spared and help needed to mobilized the patient is less-, as well as for what concerns to the anesthesia, because cardio-respiratory restrictions created by a general anesthesia in prone are greater and more severe in the obese patient. This position seems to be more suitable than other ones recommended for percutaneous nephrolithotomy in the obese patients, such as prone decubitus on a surgical saddle, or lateral decubitus position, that may compromise the radiological control of the operation.

[Laparoscopic pyelolithotomy in a pelvic kidney]. / Pielolitotomía laparoscópica en riñón pelviano.

INTRODUCTION: Pelvic renal ectopia bearing stones is a particularly rare case of complex calculi. Several percutaneous and laparoscopic procedures had been proposed in the last years to treat this challenge problem in a minimally invasive way. CLINICAL CASE: We describe the procedure of laparoscopic pyelolithotomy under general anesthesia, using three port sites, in a male patient with symptomatic stones in a left pelvic kidney with normal function. Two stones were successfully removed, with the help of flexible nephroscopy through a port, and the pyelotomy was closed with intracorporeal suture. COMMENT: Laparoscopic pyelolithotomy of a pelvic kidney is a minimally invasive technique that is not difficult to perform, making laparotomy unnecessary. Laparoscopic technique must be take into account when dealing with the infrequent complex stone patient candidate to an open stone surgery. A review of the Spanish bibliography shows this to be the second reported case of pelvic kidney calculi treated by laparoscopic pyelolithotomy.

[Low grade collecting duct carcinoma of the kidney. Presentation of one case and literature revision]. / Carcinoma renal de los conductos colectores de bajo grado. Presentación de un caso y revisión de la literatura.

Collecting duct renal cell carcinoma is an uncommon variant of renal carcinoma. Typically its behaviour is more aggressive than other forms of renal carcinoma and usually it is diagnosed at advanced stages. A 57-year-old man visited our hospital by right lumbar pain. Abdominal CT showed a enhanced mass on the right kidney. A right partial nephrectomy was done. Histological examination of the surgical specimen showed a low grade collecting duct carcinoma of the kidney. This is a new entity, with unknown behaviour but seems to be less aggressive than classical collecting duct carcinoma of the kidney. The clinical, radiological, pathological and immunohistochemical characteristics of this tumor are reported, and the literature is reviewed.

[Diffuse xanthogranulomatous pyelonephritis with a renocolic fistula neglected for more than two years]. / Pielonefritis xantogranulomatosa difusa con fistula renocólica inadvertida durante más de dos años.

INTRODUCTION: Although reno-colic fistula is a well-known complication of the diffuse form of xanthogranulomatous pyelonephritis, the features of the case here presented are unusual because of the paucity of symptoms and long lasting evolution of the disease before it was diagnosed. CLINICAL CASE: A 75 year-old woman was seen at the emergency room complaining of fever and malaise. Physical and laboratory examination showed anemia and a left abdominal mass, and on X-ray and abdominal CT, a gross stone and huge left renal and extrarenal xanthogranulomatous pyelonephritis with renocolic fistula were disclosed. A review of her clinical record showed an X-ray performed two years before by the attending family clinician, with identical gross calculi and gas into the kidney. Nephrectomy, caudal pancreatectomy and partial colectomy were accomplished with good results. COMMENT: This case of poor-symptomatic xanthogranulomatous pyelonephritis that destroyed the kidney and induced a renocolic fistula, is unusual because it was neglected for more than two years due to unawareness of the clinical and radiological picture.

Pielolitotomía laparoscópica en riñón pelviano / Laparoscopic pyelolithotomy in a pelvic kidney

INTRODUCCIÓN: El riñón pelviano afecto de cálculos es un caso particularmente raro de litiasis compleja. Diversos procedimientos, percutáneos y laparoscópicos, se han propuesto en los últimos años para resolverlo de manera poco invasiva. CASO CLÍNICO: Se muestra el procedimiento de pielolitotomía laparoscópica mediante tres únicos accesos, en un varón con cálculos sintomáticos en un riñón pelviano izquierdo con función normal. Se extrajeron dos cálculos con ayuda del nefroscopio flexible introducido a través de uno de los accesos, y cerrando la pelvis renal con sutura intracorpórea. COMENTARIO: La pielolitotomía laparoscópica de un riñón pelviano es poco invasiva y puede hacerse con facilidad, haciendo innecesaria una laparotomía. La técnica laparoscópica debe tenerse en cuenta en el infrecuente paciente con litiasis compleja en el que se considere una intervención abierta. Este es el segundo caso de riñón pelviano operado mediante laparoscopia, en la bibliografía española

INTRODUCTION: Pelvic renal ectopia bearing stones is a particularly rare case of complex calculi. Several percutaneous and laparoscopic procedures had been proposed in the last years to treat this challenge problem in a minimally invasive way. CLINICAL CASE: We describe the procedure of laparoscopic pyelolithotomy under general anesthesia, using three port sites, in a male patient with symptomatic stones in a left pelvic kidney with normal function. Two stones were successfully removed, with the help of flexible nephroscopy through a port, and the pyelotomy was closed with intracorporeal suture. COMMENT: Laparoscopic pyelolithotomy of a pelvic kidney is a minimally invasive technique that is not difficult to perform, making laparotomy unnecessary. Laparoscopic technique must be take into account when dealing with the infrequent complex stone patient candidate to an open stone surgery. A review of the Spanish bibliography shows this to be the second reported case of pelvic kidney calculi treated by laparoscopic pyelolithotomy

Pielonefritis xantogranulomatosa difusa con fístula renocólica inadvertida durante más de dos años / Diffuse xanthogranulomatous pyelonephritis with a renocolic fistula neglected for more than two years

INTRODUCCIÓN: Aunque la fístula renocólica es una complicación conocida de la forma difusa de la piel o nefritis xantogranulomatosa, describimos un caso inusual, por la pobreza de los síntomas y la larga evolución de la enfermedad antes de ser diagnosticada. CASO CLÍNICO: Una mujer de 75 años fue vista en el Servicio de Urgencias con fiebre y malestar general. El examen y las pruebas de laboratorio mostraron una masa en el hemiabdomen izquierdo y anemia, y en la radiografía de abdomen y la tomografía computarizada se encontró un cálculo grande así como una gruesa pielonefritis xantogranulomatosa con fístula renocólica. Una revisión de su historial médico mostró una radiografía de abdomen realizada más de dos años antes por su médico de familia, con el mismo cálculo y gas en la cavidad renal. Se le realizó nefrectomía, pancreatectomía caudal y colectomía parcial con buenos resultados. COMENTARIO: La pielonefritis xantogranulomatosa es una forma infrecuente de infección crónica del riñón y de los espacios retroperitoneales. Este caso poco sintomático que destruyó el riñón e indujo una fístula renocólica, es inusual porque pasó inadvertido durante años a pesar de una manifestación clínica y radiológica bastante típica

INTRODUCTION: Although reno-colic fistula is a well-known complication of the diffuse form of xanthogranulomatous pyelonephritis, the features of the case here presented are unusual because of thepaucity of symptoms and long lasting evolution of the disease before it was diagnosed. CLINICAL CASE: A 75 year-old woman was seen at the emergency room complaining of fever and malaise. Physical and laboratory examination showed anemia and a left abdominal mass, and on X-ray and abdominal CT, a gross stone and huge left renal and extrarenal xanthogranulomatous pyelonephritis with renocolicfistula were disclosed. A review of her clinical record showed an X-ray performed two years before bythe attending family clinician, with identical gross calculi and gas into the kidney. Nephrectomy, caudal pancreatectomy and partial colectomy were accomplished with good results. COMMENT: This case of poor-symptomatic xanthogranulomatous pyelonephritis that destroyed the kidneyand induced a renocolic fistula, is unusual because it was neglected for more than two years due to unawareness of the clinical and radiological picture

Carcinoma renal de los conductos colectores de bajo grado. Presentación de un caso y revisión de la literatura / Low grade collecting duct carcinoma of the kidney. Presentation of one case and literature revision

El carcinoma renal de los conductos colectores es una variante poco frecuente de carcinoma renal. Típicamente su comportamiento es más agresivo que el de otras formas de carcinoma de células renales, siendo habitualmente diagnosticado en estadios avanzados. Presentamos un caso de carcinoma renal de los conductos colectores de bajo grado. Un varón de 57 años fue admitido en nuestro hospital con clínica de cólico nefrítico. En el TAC se observó una masa en el riñón derecho y se le realizó una nefrectomía parcial. El diagnóstico histológico fue carcinoma renal de los conductos colectores de bajo grado. Es una entidad nueva, de comportamiento desconocido y aparentemente menos agresivo que el carcinoma de los conductos colectores clásico. Describimos las características clínicas, radiológicas, histológicas e inmunohistoquímicas de este tumor y revisamos la literatura

Collecting duct renal cell carcinoma is an uncommon variant of renal carcinoma. Typically itsbehaviour is more aggressive than other forms of renal carcinoma and usually it is diagnosed atadvanced stages. A 57-year-old man visited our hospital by right lumbar pain. Abdominal CTshowed a enhanced mass on the right kidney. A right partial nephrectomy was done. Histologicalexamination of the surgical specimen showed a low grade collecting duct carcinoma of the kidney.This is a new entity, with unknown behaviour but seems to be less aggressive than classicalcollecting duct carcinoma of the kidney. The clinical, radiological, pathological and immunohistochemicalcharacteristics of this tumor are reported, and the literature is reviewed

[Expression of CDX2 in urinary bladder and urethra lesions]. / Expresión de CDX2 en lesiones de vejiga urinaria y uretra.

BACKGROUND: CDX1 and CDX2 are transcription factors involved in the development and maintenance of the intestinal epithelial cell. Expression of CDX2 has been reported in normal and metaplastic intestinal epithelium, and in those adenocarcinomas with that cellular origin. We have analyzed the expression of this marker in reactive and tumoral lesions arising in urinary bladder, urethra and urachus. METHOD: CDX2 was investigated through immunohistochemistry on paraffin-embedded tissue, using the labelled streptavidin-biotin method (LSAB2, Dako) with a monoclonal antibody (CDX2-88, BioGenex). RESULTS: Expression of CDX2 was observed in intestinal-type cistitis glandularis, intestinal metaplasia of urinary bladder, bladder adenocarcinoma, mucinous urothelial-type carcinoma of prostatic urethra and urachal mucinous carcinoma. CDX2 was not detected in normal urothelium and prostatic glandular epithelium, Von Brunn nests, typical-type cistitis glandularis, glandular adenosis and transitional carcinoma. CONCLUSIONS: Lesions, both benign and malignant, with enteric-cell morphological features show positivity for CDX2. Expression of this marker is not organ-specific but is just related to a cellular phenotype. Reactivity for CDX2 in an adenocarcinoma can be consistent with an origin in urinary tract or urachus.

Expresión de CDX2 en lesiones de vejiga urinaria y uretra / Expression of CDX2 in lesions of urinary bladder and urethra

FUNDAMENTO: CDX1 Y CDX2 son factores de transcripción esenciales para el desarrollo y mantenimiento de la célula epitelial intestinal. Se ha descrito la expresión de CDX2 en el epitelio intestinal normal y metaplásico, y en adenocarcinomas originados en el mismo. Hemos analizado la expresión de dicho marcador en lesiones reactivas y tumorales de vejiga, uretra y uraco. MÉTODO: Se determinó CDX2 mediante inmunohistoquímica sobre tejido incluido en parafina, con el método de estreptavidina marcada-biotina (LSAB2, Dako) utilizando un anticuerpo monoclonal (CDX288, BioGenex). RESULTADOS: Se observó expresión de CDX2 en la cistitis glandularis de tipo intestinal, metaplasia intestinal de vejiga, adenocarcinoma vesical, carcinoma mucinoso urotelial de uretra prostática y carcinoma mucinoso de uraco. Fueron negativos para CDX2 el urotelio y epitelio glandular prostático normales, nidos de Von Brunn, cistitis glandularis típica, adenosis glandular y carcinoma transicional. CONCLUSIONES: Aquellas lesiones, benignas y malignas, con morfología de célula entérica presentan positividad para CDX2. La expresión de este marcador no es, por tanto, órgano-específica y únicamente se relaciona con un fenotipo celular. La positividad para CDX2 en un adenocarcinoma puede ser compatible con un origen en el tracto urinario o en el uraco (AU)

[Comparative study of the expression of p53, Ki-67, bcl-2 and CK20 in superficial transitional carcinoma of the bladder: correlation with recurrence, histological grade, and clinical stage]. / Estudio comparativo de la expresión de p53, Ki67, bcl-2 y CK20 en el carcinoma transicional superficial de vejiga: correlación con la recurrencia, grado histológico y estadio clínico.

OBJECTIVE: We examined the presence of p53, Ki-67, bcl-2 and CK20, as detected by immunohistochemistry, and correlated with the classic variables (grade, stage and recurrence). MATERIAL AND METHOD: The authors evaluated 57 superficial transitional cell carcinomas. Biopsy specimens examined included non recurrent transitional cell carcinomas (n = 36) and recurrent transitional cell carcinomas (n = 21). Association of bcl-2, p53, Ki-67 y CK20 index immunoreactivity with tumor grade, clinical stage and tumor recurrence was examined. RESULTS: Ki-67 and p53 expression were related to the degree of differentiation and recurrence of the disease. bcl-2 and CK20 were not correlated with grade, stage and recurrence of the disease. CONCLUSIONS: Positivity for Ki-67 and p53 increase with grade of the disease. P53 and Ki-67 are predictors of tumor recurrence for patients with superficial transitional cell carcinoma.