Hamartomatous polyp in the renal pelvis: case report and literature review

Objetivo: reportar el caso de una paciente femenina de 46 años con sospecha de tumor urotelial de tracto urinario superior quien es llevada a nefroureterectomía con cuña vesical. La patología reporta pólipo hamartomatoso en uréter proximal y pelvis renal. Materiales y métodos: paciente de 46 años con cuadro de larga evolución de dolor lumbar derecho y fiebre. Se realiza tomografía axial computarizada (TAC) de abdomen que evidencia masa endoluminal en el tercio proximal del uréter derecho con extensión hacia la pelvis renal que produce hidronefrosis marcada con disminución asociada del parénquima renal. Urografía excretora con retraso en la eliminación del medio de contraste del riñón derecho con hidroureteronefrosis grado III derecha. Se intenta realizar ureteroscopia semirrígida diagnóstica sin lograr avanzar el ureteroscopio más allá del tercio medio del uréter, y sin lograr tomar biopsia de la lesión por lo que se decide realizar nefroureterectomía con cuña vesical, la cual es llevada a cabo sin complicaciones. La patología reporta pólipo hamartomatoso de uréter proximal y pelvis renal. Se realizó una revisión de la literatura en Medline incluyendo los términos hamartoma, neoplasias fibroepiteliales, neoplasias ureterales, neoplasias urológicas, pólipos. Conclusiones: las lesiones hamartomatosas son la segunda neoplasia más común del tracto urinario superior, siendo más frecuentes en el uréter en el tercio superior y en la unión pieloureteral; en la pelvis renal se presentan en el 15% de los casos. Su incidencia tiene un pico de edad a los 30-40 años. Las lesiones en la pelvis renal son más frecuentes en las mujeres aportando el 65% de los casos reportados. No tienen etiología clara. Clínicamente se presentan con dolor en flanco y hematuria. Su diagnóstico suele realizarse luego de nefroureterectomía por alta sospecha de lesión maligna. Hay características radiológicas y anatómicas que ayudan a diferenciarlas de tumores uroteliales. Actualmente, el diagnóstico puede realizarse con biopsia por ureteroscopia flexible. Antiguamente, su manejo se realizaba por cirugía abierta; sin embargo, en la actualidad, el manejo endoscópico de tumores pequeños es el ideal.Purpose: To report the case of a 46 years/old female patient with suspected urinary tract urothelial tumor in whom a nephroureterectomy with resection of a bladder cuff is performed. The pathology reports hamartomatous polyp in the proximal ureter. Methods: A 46 years/old female patient has a long history of back pain and fever. A computerized tomography (CT) scan reports endoluminal lesion in the proximal third of the ureter with extension to the renal pelvis, with hydronephrosis and renal parenchyma atrophy. Intravenous urography shows slow contrast elimination by the right kidney and hydronephrosis. A semirigid ureteroscopy was performed, but it was impossible to continue further than the mid urether. A nephroureterectomy with bladder cuff was performed without any complication. The pathology analysis reports an hamartomatous polyp of the proximal ureter an renal pelvis. A literature review was performed in Medline with the MESH terms hamartoma, fibroepithelial neoplasms, ureteral neoplasms, urologic neoplasms, polyps. Conclusions: Hamartomatous lesions are the second most common malignancy of the upper urinary tract and are more common in the upper third of the ureter and ureteropelvic junction. They occur in the renal pelvis in 15% of the cases. Their peak incidence is during the third or fourth decade. Lesions at the renal pelvis are more commonly seen in females,accounting for 65% of the cases. They have no clear etiology. Clinically, their presentation is with flank pain and hematuria. Their diagnosis is usually made after nephroureterectomy performed due to a suspected malignancy. There are radiological and anatomical features that can allow us to differentiate them from urothelial tumors. The current diagnosis can be performed with biopsy by flexible ureteroscopy. Previously, they were treated with open surgery. Actually the recommended treatment for small tumors is an endoscopic approach

Primary non-Hodgkin lymphoma of the prostate: a case report

This report is of a 68-year-old male patient with a three-year history of severe, progressive, low urinary tract symptoms (LUTS) with a score of 20 points on the International Symptom [email protected]

Linfoma primario no Hodgkin de próstata: reporte de un caso

This report is of a 68-year-old male patient with a three-year history of severe, progressive, low urinary tract symptoms (LUTS) with a score of 20 points on the International Symptom Scale. The patient received alpha-1-blocker therapy without adequate response. Transurethral resection of the prostate was performed, and the anatomopathological report indicated the presence of a haematolymphoid small-cell neoplasia and glandulostromal prostatic hyperplasia. Posterior immunohistochemistry evaluation reported an extra-nodal marginal zone-B lymphoma non-Hodgkin lymphoma. The patient was followed up for five years by the urology and oncology departments. In the fourth year of follow-up, the patient had B symptoms (fever, night sweats and weight loss). At the same time, laboratory tests showed haemolytic anaemia; then a new bone marrow biopsy was carried out. The histopathological specimen showed six lymphoid aggregates, constituted by a B-cell population with intra-trabecular predominance and reactivity for CD20 and BCL-2. New thoracic and abdominal computed tomographies were performed without any findings suggestive of extra-prostatic spreading. Subsequently, a chemotherapy regimen was started on the patient with the following therapeutic scheme: Rituximab 375 mg/m2 IV per day, cyclophosphamide 750 mg/m2 IV per day, Vincristine 1.4 mg/m2 IV dose per day and Prednisone 40 mg/m2 on days 1–5 (R-CVP scheme) for 21 days, until he completed six cycles. No signs, symptoms or progression have been recorded

Surgical findings in scrotal exploration in pediatric patients with acute scrotum

Introducción y objetivo: La torsión testicular es una urgencia frecuente en la población pediátrica que requiere tratamiento quirúrgico de inmediato con el objetivo único de preservar la función testicular. Por esta razón, el enfoque de estos paciente debe basarse en una historia clínica completa y un examen físico detallado, a fin de lograr un diagnóstico oportuno. El objetivo del estudio es describir los hallazgos intraoperatorios en los pacientes pediátricos con diagnóstico de escroto agudo que son llevados a exploración quirúrgica. Materiales y métodos: Se realizó un estudio retrospectivo en dos instituciones, desde enero de 2009 a mayo de 2012, que incluyó todos los pacientes menores de 16 años que ingresaron al servicio de urgencias por dolor testicular y fueron llevados a exploración quirúrgica. Resultados: Ingresaron 78 pacientes con una edad promedio de 12 años (0-15 años), con dolor derecho en 43,5% de los casos y dolor izquierdo en 56,5%. El tiempo de evolución desde el inicio del dolor hasta la valoración por urología fue de 32,5 horas (1 hora – 15 días). Se realizó ecografía testicular Doppler en 59 (75,6%) pacientes. De éstos, en 59 se reportó torsión testicular, en 41 (69,4%), orquiepididimitis en 11 (18,6%), normal en 6 (10,1%), y torsión de hidátide en un único paciente (1.6%). Durante la exploración quirúrgica de los 78 pacientes, se evidenció torsión testicular en 60 (76,9%), torsión de hidátide en 11 (14,2%), testículo normal en 5 (6,4%) y epididimitis aguda en 2 (2,5%). De los 60 pacientes con torsión testicular, 22 (36,6%) requirieron orquidectomía, 27% derecha y 73% izquierda. Del total de los 59 pacientes con ecografía Doppler, se reportó torsión testicular en 41 pacientes y un hallazgo distinto a torsión testicular en 18; entre estos últimos, 7 tenían torsión testicular como hallazgo intraoperatorio. El Doppler testicular presentó una sensibilidad de 84% y una especificidad de 73,3%. El tiempo promedio de evolución del dolor en los pacientes que se llevaron a orquiectomia fue 63,18 horas. Conclusiones: La torsión testicular en la población pediátrica representa el 76,9% de las causas de escroto agudo, con una incidencia de orquidectomía del 36,6% y un tiempo promedio para este desenlace muy superior a 6 horas. Los hallazgos en la ecografía Doppler no se correlacionan con los hallazgos intraoperatorios del pacientePurpose: Testicular torsion is a common emergency in pediatric population, which requires immediate surgical treatment in order to preserve testicular function. The treatment decision should be made based on a complete medical history and careful physical examination, achieving pertinent diagnosis. The aim of this study is to describe the operative findings in pediatric patients diagnosed with acute scrotum who were taken to surgical exploration. Methods: A retrospective study was conducted at two medical centers, from January 2009 to May 2012. We included all patients less than 16 years who were admitted to the emergency room for acute scrotal pain and were taken to surgical exploration. Results: 78 patients were included, with an average age of 12 years (0-15 years). Pain was located in the right hemiscrotum in 43.5% of the patients and left in 56.5%. The time from the onset of pain to the urology evaluation was 32.5 hours (1 hour - 15 days). Testicular Doppler ultrasound was performed in 59 (75.6%) of the patients. 41 (69.4%), reported testicular torsion, 11 (18.6%) acute epididymitis, no alteration was seen in in 6 (10.1%), and hydatyd torsion in one patient (1.6%). During surgical exploration of the 78 patients, testicular torsion was evident in 60 (76.9%), hydatid torsion in 11 (14.2%), normal testis in 5 (6.4%) and acute epididymitis in 2 (2.5%). Of the 60 patients with testicular torsion, 22 (36.6%) required orchiectomy, 27% right and 73% left. Of the 59 patients with Doppler ultrasound, testicular torsion was reported in 41 and another cause in 18. Of the 18 patients who had a Doppler report different than testicular torsion, 7 had this condition at surgery. Testicular Doppler sensitivity was 84% and specificity 73.3%. The median time to progression of pain in patients who had orchiectomy was 63.18 hours. Conclusions: Testicular torsion in the pediatric population accounts for 76.9% of the causes of acute scrotum; 36.6% of the patients needed an orchiectomy. Pain began more than 6 hours before (in average) in these patients. The Doppler ultrasound findings do not correlate with intraoperative