[Significance of anemia as an independent prognostic factor in patients with renal cell carcinoma]

BACKGROUND AND OBJECTIVE

The aim of this study was to analyze the significance of anemia as well as other prognostic factors influencing survival in patients with renal cell carcinoma (RCC).

PATIENTS AND METHODS

A retrospective review of data of 316 patients who underwent surgery between 1970 and 2003 was performed. Most important known prognostic factors of RCC were investigated.

RESULTS

Most of patients had T1b-T2, low nuclear grade and single tumours. In 8.2% and 9% of cases, lymph node and metastatic dissemination were detected at the time of diagnosis, respectively. At the beginning, most frequent symptoms were hematuria and pain, with anemia (Hb >10g/dl) in 69 patients. After a median follow-up of 50 months, 24.1% of patients had a recurrence. From these, more than 50% developed recurrence within one year after nephrectomy. Advanced tumours (T3-4) consisted of high nuclear grade (III-IV) tumours, larger size tumours, with necrosis and vascular infiltration in surgical specimen, as well as lymph node and metastatic dissemination. In multivariate analysis, anemia, time to recurrence, type of treatment for recurrence as well as lymph node dissemination were independent factors of cancer specific survival.

CONCLUSION

Anemia seems to be a marker of recurrence and progression in patients with renal cell carcinoma undergoing nephrectomy. From our point of view, anemia could be considered a significantly high mortality rate for renal cancer in these patients.

[Ovarian metastasis of a primary renal cell carcinoma]

OBJECTIVE

We report one case of ovarian metastasis secondary to a renal clear cell carcinoma.

METHODS/RESULTS

52 year-old consulting for metrorrhagia with the initial diagnosis of primary ovarian carcinoma. Tumor dissemination work up tests reported a renal mass suggestive of ovarian metastasis. Surgery included hysterectomy, double annexectomy, and radical nephrectomy. Final diagnosis was renal clear cell carcinoma with ovarian metastasis.

CONCLUSIONS

Metastases to the ovary pose a diagnostic problem in their interpretation, especially when they show a similar histology to the primary ovarian tumor. Due to therapeutic and prognostic implications, it is very important to differentiate if it is a primary ovarian tumor or a metastasis from a renal carcinoma.

[Renal cell carcinoma: prognostic factors and staging]

OBJECTIVES

To evaluate the prognostic significance of the 2002 TNM tumor classification for renal cell carcinoma, as well as other factors intervening in its survival.

METHODS

Retrospective chart review of 316 renal carcinomas operated between 1970 and 2003. Twenty-five prognostic variables were analyzed.

RESULTS

The histological type was renal cell carcinoma in 90.5% of the patients. Most tumors were T1b or T2, with a Fuhrman nuclear grade I or II. Mean tumor size was 7.17 +/- 3.4 cm. Most cases had a solitary tumor. 8.2% of the patients had lymph node involvement at the time of diagnosis, and 8.6% metastases. The most frequent clinical presentations were hematuria and/or pain. Mean follow-up was 57.8 months. 24.1% of the cases had recurrence, more than 50% of them during the first year. Advanced tumors (T3, T4) had the tendency to have a nuclear grade III-IV, bigger size, necrosis, vascular involvement, lymph node involvement, and metastases. At the end of follow-up, most patients were alive and disease free. The number of months free of disease, the presence of metastatic lymph nodes, the treatment of the first recurrence and the presence of anemia were independent factors for cancer specific mortality.

CONCLUSIONS

The modification of the current classification of renal tumors pT3 and pT4 would help to a better decision-making in the therapy of tumors with vascular, perirenal fat or adrenal involvement. Anemia and treatment of the first recurrence are important factors for cancer specific survival.

[Intravesical therapy: Influence on superficial bladder cancer recurrence]

OBJECTIVES

To review the influence of various intravesical treatments on superficial bladder cancer recurrence.

METHODS

We retrospectively reviewed 473 superficial bladder neoplasias. Based on diagnosis and transurethral resection of bladder tumor (TUR BT), and depending on pathology, we proposed different adjuvant treatment and follow-up schemes.

RESULTS

The following factors were independent risk factors for a longer recurrence-free time: intravesical instillations, high dose BCG, and maintenance therapy in comparison to induction.

CONCLUSIONS

The use of intravesical instillations independently increases the time to recurrence. It was demonstrated that recurrence was significantly later when high dose BCG and maintenance therapy were employed.

A new form of presentation of renal actinomycosis: renal tumor with retroperitoneal bleeding

OBJECTIVE

The aim of this case report is to add to the literature a new case of renal actinomycosis, but with a form of presentation that has never been reported: renal tumor with retroperitoneal bleeding.

METHODS/RESULTS

We present the case of a 27-year-old woman, with a 5-month history of general syndrome and right flank pain. Radiological findings showed a right renal tumor with suspicious of retroperitoneal bleeding. Right radical nephrectomy was performed and the pathological examination of the specimen found actinomyces colonies. The patient received 8 weeks of Penicillin after surgery and had none sequelae. easily diagnosed because of non-specific clinical and radiological findings. Early diagnosis of renal actinomycosis is important to avoid surgery since actinomyces respond well to high doses of Penicillin.

[Neurosyphilis and bladder dysfunction]

OBJECTIVES

Syphilis is a systemic disease the course of which follows successive clinical stages. Central nervous system and spinal cord involvement on late phases may lead to bladder dysfunction. We report one case of neurosyphilis with associated bladder hyperreflexia.

METHODS/RESULTS

51-year-old male with the diagnosis of neurosyphilis consulting for voiding disorders with evidence of detrusor hyperactivity of neurogenic etiology on the urodynamic study.

CONCLUSIONS

The differential diagnosis of neurogenic bladder in patients with psychiatric or neurological symptoms should include neurosyphilis. Etiologic diagnosis is obtained by cerebrospinal fluid examination, and the diagnosis of bladder dysfunction by urodynamic study.

Tumor fibroso solitario pararrenal

OBJECTIVES

To report a rare clinical case of solitary pararenal fibrous tumor, analyzing its pathological characteristics and prognosis by a bibliographic review.

METHODS/RESULTS

We present the case of a 36-year-old male consulting for right flank colic pain, which was diagnosed of a solid mass in the lower pole of the right kidney and underwent right radical nephrectomy. Pathological study of the surgical specimen showed the presence of a solitary pararenal fibrous tumor.

CONCLUSIONS

Solitary fibrous tumor is a rare neoplasia, being its pararenal localization even rarer. It is a tumor with benign behavior in up to 90% of the cases. The immunohistochemical study is the key to diagnosis.

[The treatment of urinary incontinence by injectables. Analysis of our series]

OBJECTIVES

To determine the efficacy of endoscopical injections for the treatment of stress urinary incontinence (SUI), evaluating its low invasiveness and positive impact on quality of life.

METHODS/RESULTS

Belween 1997--2003 30 procedures of periurethral injection of various substances for urinary incontinence were performed at our department in women between 47-80 years. All patients were evaluated before surgery, clinically and urodynamically, in accordance to international standardized parameters (filling pressure/flow studies, maximum urethral closure pressure, LPP-leak point pressure). The kind of material employed for injection, surgical technique and satisfaction degree were also evaluated.

RESULTS

The indication for surgery was SUI in 17 cases (56.6%), and mixed urinary incontinence in 73 cases (43.3%). 16 cases (53.3%) had history of previous surgery for SUI. Regarding urodynamic parameters, 19 patients (63.3%) have a maximum urethral closure pressure below 25 H2O cm, and 22 patients (73.3%) had a leak point pressure below 60 H2O cm. Collagen was employed in six cases (20%) and macroplastic in 24 (80%) (14 of them with the MIS system). 22 patients had three injection sites (73.3%). Mean follow-up was 38 months. Continence outcomes were evaluated in relation to complete continence (12 cases, 40%), mild incontinence and patient satisfaction (11 cases, 36.6%), and severe incontinence (7 cases, 23.3%).

CONCLUSIONS

1-To achieve acceptable results it is mandatory to do the best possible indication (Mc Guire type III SUI). 2.-There is an excellent relationship between minimal invasiveness and good results.

[Spontaneous regression of venous thrombus in a case of renal carcinoma]

OBJECTIVES

To report the first case of spontaneous regression of renal vein and inferior vena cava thrombus in a patient with renal clear cell carcinoma.

METHODS/RESULTS

We describe the case of a woman with the diagnosis of renal mass with venous thrombus of the renal vein and inferior vena cava. Extension studies before radical nephrectomy showed regression of the thrombus which was confirmed during nephrectomy.

CONCLUSIONS

Spontaneous regression of clear cell renal carcinoma metastases is estimated below 1 % of the cases. This is the first case report of regression of a tumoral thrombus of the renal vein and inferior vena cava.

[Relationship between LUTS (lower urinary tract symptoms) and quality of life]

OBJECTIVES

To evaluate the impact of the lower urinary tract symptoms (LUTS) included in the IPSS on the quality of life and to determine the relationship between quality of life or total IPSS score and treatment.

METHODS

Retrospective review of the IPSS questionnaire in 125 male patients who had consulted for LUTS between January 2001 and December 2003. Results were included in an Access database. Statistical analyses were done with the SPSS 11.0 software.

RESULTS

17% of the patients showed severe symptoms in accordance to the IPSS score. In the quality of life evaluation grouped into two categories, 88% referred good or indifferent quality of life. In the evaluation of the association between IPSS individual questions and quality of life there was a significant association for all questions. Patients reporting worse quality of life had a 6 times higher risk of receiving treatment. With a mean follow-up of two years, 91% of patients who were not on treatment continued without it.

CONCLUSIONS

The most severe symptoms are, the worse the quality of life. The independent parameters that most influenced decision to start treatment were quality of life and total IPSS. Frequency, weak stream and hesitation may explain quality of life on each patient.

[Bladder metastasis of renal carcinoma]

OBJECTIVES

We report the case of a patient who had underwent surgery for a clear cell renal carcinoma 2 years before presenting with metastasic extension to bladder on follow-up.

METHODS

Radiological finding of a bladder mass during follow-up after nephrectomy.

RESULTS

TURBT was carried out with the pathologic report of clear cell carcinoma, compatible with a primary renal origin.

CONCLUSIONS

Bladder is a very rare place for metastasis from kidney tumors. Prognosis will depend on the time of appearance of such metastases.

[Obstructive urethral angioleiomyoma]

OBJECTIVES

To report one case of urethral angioleiomyoma because of the rare site, and to review its main characteristics.

METHODS

We report one case of male urethra angioleiomyoma presenting with obstructive symptoms.

RESULTS

We performed excision and end to end anastomosis of a small bulbar urethra stenosis. Pathology reported angioleiomyoma.

CONCLUSIONS

Angioleiomyoma is a benign tumor arising from smooth muscle within blood vessel walls. It is extremely rare in the urethra. It is more common in females. Recurrence and metastasis are exceptional. It shows scarce or moderate cellularity with predominance of fusiform cells. They may express smooth muscle vimentin, desmin, and actin. The best therapeutic option is resection.

[Cystic hamartoma of the renal pelvis: unfrequent finding]

OBJECTIVES

This cystic hamartoma of the renal pelvis is a very unfrequent benign tumor. We report one case emphasizing its histology and performed a bibliographic review.

METHODS

Mid age female patient with the incidental diagnosis of a renal mass taking up the pelvis.

RESULTS

A radical nephrectomy was performed with the pathologic report of cystic hamartoma of the renal pelvis.

CONCLUSIONS

It is a cystic renal tumor with well-defined histologic and immunohistochemical criteria, and it probably does not involve any danger for the patient's live.

[Treatment of a cavernous hemangioma of the bladder by endoscopical resection]

OBJECTIVES

We report three cases of bladder hemangioma.

METHODS

Three cases of cavernous hemangioma of the bladder with pathologic confirmation treated by endoscopical resection.

RESULTS

There is no evidence of recurrence in either patient after resection.

CONCLUSIONS

The endoscopical treatment of small bladder hemangiomas is an effective treatment.