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ABSTRACT: 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.
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.
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.
Cirugia y cirujanos 05/2011; 79(3):260-3, 282-5. · 0.14 Impact Factor
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ABSTRACT: Prostatic cysts are rare lesions with a reported incidence from 1 to 7.9%. They have been associated with primary infertility. The main characteristic is the benign course and positive prognosis after correct surgical management.
We present three clinical cases, two with primary infertility and another with a history of primary infertility who presented with recurrent hemospermia and refractory medical treatment. All patients had hypospermia and alteration of the seminal parameters represented by moderate oligospermia (MOS), asteno- and teratozoospermia, in addition to hemospermia in two patients. Diagnosis was confirmed by transrectal ultrasound. Transurethral resection (TUR) of the cyst was performed in two cases and resection of the veru montanum in one, obtaining improvement in the seminal parameters after 1 month of follow-up and acceptable parameters for spontaneous conception at 6 months.
Infertility associated with partially obstructed ejaculatory ducts may be suspected clinically by hypospermia. Transrectal ultrasound is essential to confirm the diagnosis. TUR of this lesion reestablishes the free passage of semen in almost all patients, with potential recovery of fertility 6 months after treatment.
Cirugia y cirujanos 76(4):349-53. · 0.14 Impact Factor
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ABSTRACT: 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.
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.
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.
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.
Cirugia y cirujanos 77(1):33-8. · 0.14 Impact Factor
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ABSTRACT: 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).
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.
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.
Prostatic neuroendocrine carcinoma is uncommon, aggressive and represents a prostatic neoplasia without PSA expression. In advanced disease, very low response is reached with ADT.
Cirugia y cirujanos 77(4):293-9; 273-8. · 0.14 Impact Factor
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ABSTRACT: We undertook this study to determine the efficiency of ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. suspicious sonographic areas.
Medical files and histopathological reports were reviewed of patients who were treated at the Specialties Hospital of the 21st Century Medical National Center in Mexico City with suspicion of prostate cancer (T1, T2 and PSA <10 ng/ml). Patients had ultrasound-guided transrectal prostate biopsy applying two techniques: systematic extended vs. hypoechoic suspicious sonographic areas. Studies were carried out from January 1, 2005 to July 2006.
Of 145 selected patients submitted to ultrasound-guided transrectal prostate biopsy, systematic extended biopsy (group I) was carried out in 73 (50.3%), taking on average 11.75 cylinders per patient. In 72 (49.6%) patients, biopsies were taken on suspicious sonographic areas (group II), taking on average 4.02 cylinders. In group I, 36 (49.3%) patients were positive vs. group II, where 20 (27.7%) patients were positive (p <0.01) with an estimation of risk in favor of group I, determining a probability 2.5 times higher of positivity with this technique (95% confidence interval: range 1.2-5) and a better performance in 22%.
Systematic extended ultrasound-guided transrectal prostate biopsy represents a technique with a higher rate of efficiency than using ultrasound-guided transrectal prostate biopsy in suspicious sonographic areas and has proven over time to be the superior prostate biopsy technique for diagnosis of prostate cancer. It must be considered the method of choice.
Cirugia y cirujanos 76(2):139-43. · 0.14 Impact Factor
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ABSTRACT: We present the results of patients submitted to a Studer type urinary orthotopic derivation after radical cystectomy.
The files of patients with bladder cancer submitted to a radical cystectomy plus the procedure of the ileal neobladder were reviewed in our hospital from January 1992 until December 2004. Patients were divided into two groups: group A--60 years old or younger and group B-->60 years old.
From 306 patients submitted to radical cystectomy with urinary derivation, there were 42 patients (13.7%) included with Studer type neobladder. There were 34 (80.9 %) men and 8 (19.1%) women, with an average age of 60 years. Average surgical time was 7 h with an average blood loss of 1600 cc requiring transfer to intensive care unit (ICU) in 55% of the cases. The most frequent early complication was metabolic acidosis that was present in 28 (66%) patients. The most severe complication was ileal-ureter urinary leak, which was present in seven (16.6 %) patients. Among the most frequent late complications are the day- and night-time urinary incontinence often related to urinary infections and intestinal occlusion. Overall 5-year survival was 71%, cancer-specific mortality was 15% and surgical-related mortality was 7.3%.
The performance of procedures with orthotopic neobladders is actually feasible in experienced hospital centers and is a valuable alternative to urinary heterotopic derivation with ileal conduit. Postoperative patient management and regular follow-up is of major importance.
Cirugia y cirujanos 77(6):411-7. · 0.14 Impact Factor
