Biomedical subjects
Publications and source records attributed to E Zungri.
We report the appearance of three cases of Leydig cell tumours on MRI. This imaging method showed well-defined and peripheral intratesticular tumours displaying marked and homogeneous enhancement when contrast medium was used. This latter finding was only observed in Leydig cell tumours when they were compared in a series of 104 patients with different scrotal pathologies.
A 44-year-old woman with left kidney tumor involving the perirenal and retroperitoneal lymph nodes is presented. Imaging findings including ultrasonography and computerized tomography showed renal and para-aortic masses and no features of lymphangioleiomyomatosis or angiomyolipoma were seen. The histopathological examination was considered as a renal smooth muscle tumor with features of lymphangioleiomyomatosis. Diagnosis considerations, particularly histopathological, immunohistochemical and hormonal studies are discussed and we comment the distinction of this case from the benign mesenchymal tumors.
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OBJECTIVE: Transurethral resection (TUR) is the elective procedure in the treatment of superficial bladder tumor. The association of intravesical chemotherapy has no influence on survival and cause specific survival. This study was carried out to determine the evolution of T1 GIII bladder carcinoma treated with TUR only. PATIENTS AND METHODS: We retrospectively reviewed the records of 42 consecutive patients with T1 GIII bladder carcinoma. Follow-up was available for 34 patients. No patient received either adjuvant or neoadjuvant therapy. All the patients were treated with TUR only and followed for a median of 40 months. They were followed by cystoscopy, urinary cytology and intravenous urography. RESULTS: Forty-seven percent of patients had a solitary tumor while 53% had multiple tumors. Tumor recurrence occurred in 50% with a disease-free interval until the first relapse of 9.6 months. Progression of the primary tumor was observed in 23.5% of patients. The overall survival rate was 73.6% and the cancer-specific survival estimate was 88.2% at mean 36 months of follow-up. CONCLUSIONS: T1 GIII bladder carcinoma may be treated initially with transurethral resection only with acceptable recurrence and progression rates. This would avoid costs and complications of the adjuvant/neoadjuvant therapies.
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The germinal cell tumor represents the most common malignancy of the testicular tissues. Benign testis tumors are exceptional, and in this situation organ preservation should be considered. The adenomatoid tumor is the most common paratesticular type with anatomic distribution limited to the epididymis, testicular membranes and rarely to the spermatic cord. Its intratesticular localization is very rare. We report here the clinical case of a 32-year-old man with a testicular tumor who came to our department with a 6-month growth of a testicular mass (normal alpha-fetoprotein and beta-HCG). The pathologic report revealed a solid and small tumor at the lower pole of the testicle with total intratesticular tumor growth (adenomatoid tumor of intratesticular localization). Because of its rarity, the clinical, diagnostic and therapeutic aspects and the possibilities of testicular preservation are discussed.
Between November 1992 and March 1993 our Service conducted a campaign for early detection of prostate disease among the male population of Vigo. The study focused in the relationship of PSA with the age, rectal examination and prostate symptomatology score. In view of the results obtained it has been concluded that PSA levels increase gradually as a function of age, volume and prostate symptomatology score.
Case report of a 49-year old male patient who presented with signs and symptoms in agreement with Cushing's Syndrome, the etiology of which was shown to be an ACTH-independent macronodular hyperplasia. In such cases, the therapeutical choice is bilateral adrenalectomy which was adopted by us using a posterior approach. The relevance of the clinical diagnosis and therapeutical aspects of this condition are reviewed.
Contribution of two cases of congenital adrenal hyperplasia by blockade in the 21-hydroxylase enzyme synthesis. Diagnosis was reached from the clinical signs and symptoms (virilization syndrome), and was confirmed by radiological and laboratory tests. Hormone treatment was done with hydrocortisone and fludrocortisone, but surgical correction of external genitalia was required to improve cosmetic appearance.
Adrenal hypertension is an uncommon phenomenon. When seen in association with hypokalemia the existence of primary aldosteronism, the most frequent cause of which is an adenoma of the adrenal gland cortex, should be suspected. This paper contributes one case of primary aldosteronism treated by unilateral resection of the adrenal adenoma, with no surgical complications and good medium-term results.
Emergence of multiple bilateral renal cysts observed in patients undergoing periodic haemodialysis is 40%. The pathology, known as Acquired Cystic Renal Disease (A.C.R.D.) presents a high association to renal cancer. Two cases of A.C.R.D. and their association with hypernephroma, one resulting in secondary retroperitoneal haemorrhage and the other in intracystic haemorrhage, are presented. Forms and diagnosis are analyzed, insisting upon the need of monitoring the patients in haemodialysis from the point of view of tumour emergence.
Between 1938 and 1985, 73 patients with ureteral tumors underwent surgery at Puigvert Foundation (1 case with bilateral synchronous tumors). Sixty-three patients were males and 10 females. Ages ranged between 49 and 78 (mean of 62) years. Tumoral stages were: pTa 5 cases; pT1 56 cases; pT2 10 cases, and pT3 2 cases. Radical treatment was performed in 38 cases and conservative treatment in 35 cases. Follow-up ranged between 2 and 20 (mean of 7) years. The overall survival rate at 5 years was 100, 82 and 50% for stages pTa, pT1 and pT2-3, respectively (p less than 0.05). Analyzed together, the actuarial survival at 5 years was 90.3% with conservative surgery and 67.8% with radical surgery (p not significant). The survival by stages for the patients treated with radical surgery was: 100% in pTa; 69.6% in pT1, and 57.1% in pT2-3. For those treated conservatively, survival was 100% in pTa, 95.8% in pT1 and 33.3% in pT2. Thus patients presenting with infiltrating tumors should not be treated conservatively, while patients with superficial lesions had a similar evolution whether treated by conservative or radical surgery.
In the course of stagging for genitourinary malignancy, we identified 9 patients with asymptomatic bone lesions. Biopsies were taken in all cases. In 5 patients, biopsy revealed Paget's disease and, in 3 others, a solitary bone metastasis was confirmed, which demonstrates the utility of this method by avoiding unnecessary, high-risk surgical procedures. In 1 patient the biopsy was normal.
We report on our experience with 21 patients with superficial bladder cancer who were treated with intravesical BCG instillation. The BCG vaccine was effective in the treatment of carcinoma in situ. Tumor regression was achieved in 83.3% at 3 months, and 61.1% at 24 months. It is advisable to follow patients closely because of the possibility of tumor progression.
Between January 1978 and June 1985, 44 patients underwent cystectomy for clinically diagnosed superficial bladder cancer. Operative mortality was 13.6%. Early and late complications were observed in 34 and 55% patients, respectively. Clinical understaging was seen in 23%, and stage reduction in 18% of the patients. Clinical staging was correct in 59% of the patients. The mean follow-up was 40 months (range, 24-84 months). Five patients presented local recurrence (13%) of the tumor and 10 patients showed distant metastases (26%). Urethral and upper urinary tract recurrences were observed in 7 and 4 patients, respectively. Fourteen patients (39%) died of cancer after a mean follow-up of 24 months. The actuarial 5-year survival was achieved by 77% of the patients with PTo-PTa-PTis and by 67% of the patients with PT1 (p, not significant).
Endourological techniques allow one to postpone a second, planned intervention--urinary diversion to the intestine--in radical cystectomies with a high surgical risk. PTU consists in introducing one nephrostomy tube percutaneously through one kidney and replacing it by the definitive drainage tube during the surgical procedure after suturing both ureters together.
Of the 241 patients with bladder cancer treated with cystectomy and urinary diversion between January, 1978, and May, 1985, pelvic lymphadenectomy was performed in 150. In 41 of the 150 patients, pelvic node involvement was shown in the pathology study (27%). The preoperative clinical stages showed bladder muscle invasion in all 41 cases. Node invasion was found in 16/77 cases with radiation therapy and in 25/73 cases without radiation therapy (p less than 0.05). Operative mortality was 3 cases (7.3%). Of the 38 patients who survived the operation, 35 (94%) died of cancer within an average of 8 months. Twenty-seven showed 1-3 pelvic nodes involved, 7 showed 4-6, and 4 patients had more than 6 nodes involved. These differences between survival rates are not statistically significant (p = 0.35). Two patients died of a disease not related to the tumor, and only 1 is alive 4 years after operation (2%).