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Prostate Cancer (PCa) represents the most common malignant tumor in men but according to the European Association of Urology (EAU) guidelines, a mass screening for PCa diagnosis should not be performed due to over-diagnosis and over-treatment related problems. An early clinical diagnosis is possible, mainly based on digital rectal examination and Prostatic Specific Agent (PSA) testing. However, the only mandatory test to define the presence of PCa is ultrasound guided-biopsy, obtained on multiple samples, which has also a high prognostic value. In this context, diagnostic imaging plays an important role as confirmed by EAU that in a 2016 update of their guidelines on PCa stated the importance of Positron Emission Tomography (PET) with 11 C- or 18 F-choline combined with computed tomography (CT) to identify local relapse, lymph node involvement and metastatic spread at all stages. Consequently, in 2017, the European Association of Nuclear Medicine (EANM) together with the Society of Nuclear Medicine and Molecular Imaging (SNMMI) published new guidelines for 68 Ga-Prostate Specific Membrane Antigen (PSMA) PET/CT to help physicians in the recommendation, execution and interpretation of PET/CT scans in patients with PCa. Thus, the aim of this 'evidence paper' is to define the current diagnostic algorithm in PCa in order to increase the general level of confidence in approaching such a crucial topic., (Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.)

Introduction: The only curative treatment of pelvic recurrence of rectal cancer is radical resection. The aim of this paper is to analyze our experience in surgery for local recurrence of rectal cancer., Methods: We performed a descriptive retrospective analysis of patients treated with curative intent for local recurrence of rectal cancer from May 2000 to January 2014. The presence of resectable liver or lung metastases was not an exclusion criterion. The descriptive results, overall survival and disease free survival are presented., Results: A total of 35 patients were included. In 18 patients an abdomino-perineal resection of the remaining rectum was performed. Two of them included excision of lower sacral vertebrae, while in 17 patients, sphincter sparing surgery was performed. The most frequent postoperative complications were pelvic collection and postoperative ileus. Seven patients required reoperation and one patient died. Overall survival at one year was 91.2%, at 2 years 75.6% and at 5 years 37%., Conclusions: Local recurrence of rectal cancer is a disease with high curability rate. The only curative option is radical surgery, with acceptable mortality., (Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Groove pancreatitis (PS) is an uncommon clinical situation and radiologically it can mimic carcinoma of the periampullary area. The aim of this paper is to study a series of 8 patients who underwent surgery with preoperative diagnosis of pancreatic head mass and subsequent pathological diagnosis of PS., Methods: In our series, 6 were men and 2 women, with an average age of 51,9 years. Before surgery, all patients had epigastric abdominal pain requiring analgesia at high doses. The preoperative analytical CEA and Ca 19.9 were normal in all patients. Imaging studies showed intrapancreatic solid lesions in 6 of the 8 patients, and in the remaining 2 one papillary mass of 5 and 6cm, respectively, that caused stenosis in the duodenal luz. EUS neoplastic cells were negative in all patients., Results: The immediate postoperative evolution was satisfactory, there are no complications. In our series, no patients have died. The long-term follow-up, in 7 of the 8 patients, has been excellent with disappearance of abdominal pain and improvement of nutritional status. The remaining patient had frequent recurrent episodes of acute pancreatitis, and at 60 months, presented a pseudocyst that has required a Roux-en-Y cystojejunostomy., Conclusions: PS must be included in the differential diagnosis of pancreatic lesions, which may include carcinoma of the periampullary area and other causes of chronic pancreatitis., (Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.)

Barrett's esophagus is an acquired condition that results in a serious injury of the esophageal mucosa and whose importance lies in the possible progression to esophageal adenocarcinoma. The incidence of esophageal adenocarcinoma continues to rise in the Western world, being survival rate very grim when diagnosis is made in later stages. For this reason the current strategies to improve survival in patients with esophageal adenocarcinoma focus on cancer detection at an early and potentially curable stage. This purpose could be achieved either by screening patients most likely to have Barrett's esophagus or by endoscopic surveillance in patients with known Barrett's esophagus. However, the detection and monitoring strategies are currently invasive, expensive and with not really proven benefit. However, new techniques have been and are developed to improve the diagnosis and treatment in order to change the current reality. The aim of this paper is to update the reader on this pathology in terms of pathophysiological and epidemiological aspects, but especially in relation to advances in diagnosis and endoscopic treatment. We also propose a guideline for monitoring and clinical management in this group of patients.

Objectives: To review the various methods to predict the risk of having prostate cancer, or that localized disease may be cured or progress after a given treatment., Methods: We performed a review of the various mathematic models known for the probability analysis of the event, with a critical analysis of weaknesses and strengths of each method. In a Medline update we review the most relevant papers referred to diagnosis and management of localized prostate cancer in its diagnosis and management sides, as well as the probability of developing metastatic disease and to die., Results: There are multiple methods and models to predict the various events in a patient candidate to diagnosis of prostate cancer, as well as to analyze the possibilities of success of a specific treatment, in many cases with an important exactness. We emphasize the heterogeneity in the methods, data and variables used for the analysis, basically about retrospective studies. Many of the most sophisticated methods, Neural Network or cart, do not present greater exactness than classic methods like logistic regression., Conclusions: Predictive models are an important element for decision making in usual clinical practice, favoring the decision of a diagnosis or certain treatment is not taken in a random manner and therefore it is taken following scientific criteria. Waiting for more precise methods, we have to know no method is perfect, and therefore it is an important tool, which should not by pass personal knowledge or the experience of a specific working group.

Objective: The robotic technique has been associated with a decreased LC for radical prostatectomy. The objective is to review the literature in search of any evidence that the RALP is able to shorten the learning curve for radical prostatectomy compared to the open and pure laparoscopic techniques., Methods: A Medline search of the English-language literature was performed to identify all papers published relating to RALP and LC., Results: There is substantial variability in the RALP literature regarding the number of cases a surgeon needs to achieve and sustain in time acceptable operative times and reasonable outcomes. The information on RALP LC comes from isolated single institution reports with questionable methodological analyses. There are no studies comparing the LC of RALP with open or pure laparoscopic techniques., Conclusions: There is no reliable information to support the notion that RALP shortens the prostatectomy LC. The evidence is limited to case series, with a Level of Evidence 4.

Unlabelled: Human papillomavirus (HPV) is the main cause of cervical cancer. Thus, HPV detection and typing becomes important in order to know the frequency of genotypes present in the region. In this paper we studied 44 biopsies of cervical adenocarcinoma. For HPV detection nested polymerase chain reaction (PCR) was used to amplify the L1 gene. For viral typing restriction enzymes (Rsa I, Dde I, Pst I) and DNA sequencing were used. Viral DNA was detected by nested L1 PCR in 100% of biopsies; 38/44 cases could be typed: 81.6% HPV16; 13.2% HPV 18; 2.6% VPH 33 and 2.6% HPV 18/33., Conclusions: The technique was successful in identifying the virus type in 86% of biopsies. There was a strong association ACC-HPV, especially with the viral type 16, detected in 81.6% of established cases.

Objective: To report one case of metastatic prostatic carcinoma with a gaudy presentation as a lump which resulted to be a cutaneous metastasis., Methods: We describe the debut in a patient, who thanks to the pathologic analysis of a lesion mimicking a lipoma, which was reported as adenocarcinoma, was worked up for prostatic adenocarcinoma and diagnosis was reached. We performed a bibliographic review using an electronic bibliographic search in PubMed (MEDLINE) using the terms "Prostatic Neoplasm" (MesH) AND "Neoplasm Metastasis" (MesH) AND "cutaneous" (free text). Most publications are case reports reviewing the probable dissemination way and localization., Results: Positive immunohistochemical staining for PSA confirmed the origin of the metastasis, although PSA value did not offer doubts due to its value over 1100 ng/ml. Regarding the bibliographic search we obtained more than 26 papers, and selected only 8 that were adjusted to the objectives of our work. Cutaneous metastasis of prostatic origin appear in less than 0.3% of the cases, because bone, lymph node, and visceral disease are more frequent. Cases appearing during the evolution of the disease and metastasis after laparoscopic procedures are described., Conclusions: Cutaneous metastases of prostatic adenocarcinoma are very rare, but even rarer is it being the debut of the disease.

This paper reviews the morphological cancer diagnosis criteria on needle biopsies, the predictive meaning of the pathological lesions of HGPIN, HAA, and P.I.A and the peculiar histopathological patterns in prostatic adenocarcinoma. We present the histological parameters that the pathologist has to informe in the diagnositic, on the routine prostate needle biopsy: Gleason histological degree, histological type, number of invaded cilindres, percentage of tumor in each cylinder, location of the biopsy and ymphovascular invasion. We also emphasize the importance of new predictive biomarkers nowadays in study and probably involved in tumor progression.

The symptomatic infiltration to bone marrow by gastric carcinoma is an extremely infrequent condition even so as an early manifestation. Very few reports exist in the worldwide literature about it. In this paper we report a case of a 47 years woman who was attended in our Institute because of the presence of thrombocytopenia, anaemia, fever involuntary weight loss and linfadenopathy, and also dyspepsia. Through her diagnostic evaluation the diagnosis of an occult gastric cancer was established. The aim of this report is to present the clinical, radiological and pathological characteristics of this unusual presentation of gastric cancer; and also we present a brief literature review of the cases that had been reported and their clinical implication.

Objective: Cryosurgical ablation (CSA) is one treatment option that has been developed and it is now recognised as a true therapeutic alternative in the treatment of localised disease. The aim of this paper is to present the preliminary experience with CSA in prostate cancer from the centre in Norway., Materials and Methods: A total of 132 patients with prostate cancer have been treated with CSA since September 2003. In 90 patients, CSA was the primary therapy used and these patients included those with low (LR; n=27), intermediate (IR; n=37) and high risk (HR: n=26) disease. Low risk patients were defined as those with T1a-T2a, NO, MO, Gleason score < or = 6 and prostate-specific antigen (PSA) <10 ng/ml. Intermediate risk were patients with T2b tumours or a PSA level of 10-20 ng/ml or Gleason score 7. High risk were defined as those with T2c tumours or Gleason score >7 or PSA >20 ng/ml. The remaining 42 patients either had locally advanced disease or had received salvage treatment after previous external beam radiation (EBRT), cryotherapy or hormone treatment. Patients were evaluated at 3 and 6 months and thereafter at 6 month intervals. A voiding history was taken and the following tests conducted: uroflowmetry, residual urine., Results: Results are presented for those patients receiving CSA as a primary therapy. Currently, the longest follow-up period is 42 months. The median observation period is 21 months and 39% of patients have been seen at the 24-month follow-up visit. No evidence of clinical progression has been observed in patients in the LR or HR group. Two patients in the IR group had clinical evidence of progression. The most common side effects seen during the first year post CSA were urinary tract obstruction and the need for removal of dead prostatic tissue or calcifications. Histological examination of the removed tissue did not shown evidence of prostate cancer. All patients in the LR and IR group that were sexually active before treatment were also sexually active on last follow-up, 37% using some kind of aid. 86% of patients in the LR and IR groups reported no bother as to sexual function., Conclusions: CSA is now recognised by the EAU as a true therapeutic alternative for the treatment of prostate cancer. Many institutions offer CSA only to older patients due to the lack of long-term data. If longer follow-up data confirm the short-term effect seen in my series, and if comparable side effects are reported in other studies, CSA might also be offered as primary treatment to younger patients.

Background: The objective of our paper is to report on the long-term results of patients with gastric cancer treated by mini-invasive surgery with "intention-to-treat" laparoscopy., Patients and Methods: Between June 1993 and January 2006, 130 patients comprising 94 men and 36 women with gastric adenocarcinoma were prospectively selected by two surgical teams in three hospitals based on a prior agreement (CHU Charleroi, Belgium, Centre Hospitalier de Luxembourg and Zumárraga Hospital, Spain). Patients with adenocarcinoma of the cardia were excluded. Mean age of patients was 68 years (range, 37-85 years)., Results: Post-operative mortality within 60 days of operation was 6 patients; 109 patients were therefore properly followed up for an average of 49 months (range, 2-153 months).Average survival time for 10 non-resected patients was 4.5 months. Average survival rate for all 14 palliatively resected patients was 6.9 months. Actuarial 5-year survival rate for R0-type surgery was 35%. Global actuarial 5-year survival rate after resective surgery was 31%., Conclusions: Laparoscopic gastrectomy with any kind of lymphadenectomy is a major but safe operation with acceptable mortality and morbility rates in patients with advanced gastric cancer, usually in poor general condition. Laparoscopic gastrectomy for locally advanced cancers is equivalent to laparotomy as far as long-term oncological results are concerned.

Objectives: The diagnosis of prostate cancer has changed significantly with the introduction of PSA in the clinical practice. Despite screening is under controversy the use of PSA has become widespread. The objective of this paper is to know the use of PSA in our health-care area and to analyze perceived risks and benefits., Methods: From the informatic archives we analyze PSA determinations performed in our health-care area (290.956 citizens) over 2000 and 2001. We also analyzed prostate biopsies generated and number of cancers detected., Results: 25.519 PSA determinations were performed. 59% came from general practitioners (GP), 34% from urologists and 7% from the rest of specialists. 39% are performed to men older than 70 years. PSA was normal in 78.7% of the patients and higher than 4 ng/ml in 21.2%. 488 prostatic biopsies were performed diagnosing 178 cancers (diagnostic yield 36.5%). Depending on the first PSA, diagnosis was started by a GP in 44% of the cases, a urologist in 46%, and the remaining 10% by other specialists. Mean time from first PSA to diagnosis was 5 months, without significant differences between GPs and specialities . The use of PSA by GPs is variable (between 8.1 and 45.8 determinations per 100 men over 50 years), without significant differences in prostate cancer detection by number of PSAs or differences in age. In comparison with the period 1982-1993 the incidence of prostate cancer goes from 30.76 to 52.8 new cases/100.000 inhabitants/year. There is a greater incidence and increase of cancer in the rural area (from 33.52 to 221.1 new cases/ 100.000 inhabitants/year)., Conclusions: We confirm the general use of this test and the trend to screening in the primary health-care level, which participates in an important manner in the diagnosis. PSA brings forward the diagnosis of prostate cancer 5 years in our area, and shoots its incidence rates. The high use of such marker in our population of advanced age may be considered inadequate.

Objective: The aim of this paper is to evaluate the evolution in the clinical, echographic and pathological characteristics of patients undergoing transrectal ultrasound and prostate biopsy over a 10 year period (1994-2003)., Material and Methods: Patients undergoing a first biopsy of the prostate between 1994-2003 were studied retrospectively. Since the biopsy criteria have changed several times over this period, results were analysed for four different periods: 1994-1997, 1998, 1999-2003 (the latter was further divided into two periods--1999-2001 and 2002-2003--to observe the temporal evolution with the same biopsy criteria). Patients were assigned to risk groups according to D'Amico., Results: We observed that individuals referred for biopsy and those diagnosed with prostate cancer (PC) had a lower mean age (p=0.0001 and p=0.01), there were more patients with a PSA from 4.1-10 ng/ml (p=0.0001 and p=0.0001), more patients had no significant DRE findings (p=0.0001 and p=0.0001) or ultrasound findings (p=0.0001 and p=0.0001). The incidence of cancer diagnosis has decreased from 39.4% to 34.3% (p=0.03). There was an increased incidence of score 7, at the expense of a decline in scores 5-6 and 8-10 and disappearance of score 2-4 (p=0.0001). Patients assigned to the low risk group increased from 9% to 18.1%, those assigned to the intermediate risk group from 20.2% to 43.1% and there was a reduction in those assigned to the high risk group from 70.7% to 38.7% (p=0.0001). Analysis of the final two time periods revealed that the evolution of the series remained the same except for a decrease in age at biopsy and diagnosis of cancer., Conclusions: Nowadays, the risk factors of patients with an indication of biopsy have less weight than ten years ago. We currently diagnose patients with PC with more favourable prognostic factors. However, the price we pay for this earlier diagnosis is reflected in a less effective biopsy, a larger proportion of the population without PC having to experience the physical complications and psychological stress of a biopsy, a greater number of patients having to undergo a second biopsy and, therefore, a greater and more costly use of resources to diagnose PC.

Acquired cystic renal disease (A.C.R.D.) is a risk factor for the development of renal carcinoma in the patient's own kidney after renal transplant (R.T.), development of a primitive tumor in the renal graft is infrequent, but the presence of metastasis of an epithelial tumor is very rare. This is the second case reported in the literature of metastasis of an epithelial tumor in the renal graft and the first case described of renal cell carcinoma metastasis (R.C.C.) in the renal graft. This paper describes the case of a patient with a normally functioning renal transplant and A.C.R.D. who develops RCC in his own kidney, with metastasis in the renal graft.

Introduction and Objectives: Non-transitional cell tumours of the bladder are both a diagnostic challenge for the pathologist and a therapeutic challenge for the urologist, because although uncommon (less than 5% of all malignancies of the bladder) they show different biological behaviours each requiring a unique approach. The most significant pathoanatomical types are: primary epidermoid carcinoma, primary adenocarcinoma and primary sarcoma. This paper presents an analysis of our experience in these types of tumours., Material and Methods: A retrospective study of unusual cases of cancer of the bladder seen in our hospital between 1988-2001. Their biological behaviour and the therapies applied are analysed. The extravesical origin of the tumour was ruled out in all cases., Results: We found 21 cases of the following pathoanatomical varieties: 13 epidermoid carcinomas, 7 adenocarcinomas (3 urachal) and 1 sarcoma. Mean age was very different between epidermoid carcinomas (69.2 +/- 9.1 years) and adenocarcinomas (50.3 +/- 8.1). Tumour behaviour was very aggressive in all three histological varieties. At the time of diagnosis 19 patients had locally advanced stages (> or = T2). Although elective therapy was cystectomy, this was only feasible in 10 cases. Systemic chemotherapy (most frequently M-VAC) and/or local radiotherapy was used in 7 cases. 14 patients have died after a mean survival of 15.7 +/- 11.6 months., Conclusions: Late diagnosis of these tumours and their aggressive biological behaviour involve a gloomy prognosis. Only early diagnosis and radical therapy could improve the prognosis.

We include those patients who present with an isolated metastasis of axillary adenopathy in the occult primary breast cancer group. Presumably, the primary tumor is a primitive breast carcinoma, unsuspected until this moment and not clinically demonstrable by mammography or ultrasonography. When no method succeeds in confirming the primary breast lesion, the patients are usually treated assuming the existing of breast cancer. Several diagnostic methods have been used to find the primary breast lesion. Magnetic Resonance imaging (MRI), Positron Emission (PET) and Doppler sonography have been used in this way and several papers present the results reached with them. Our group incorporates detection and radioguided surgery with 99mTechnetium (99mTc) methoxyisobutil isonitrile into the study of these patients. We perform a planar scintimammography and SPECT (Single Photon Emission Computed Tomography) with 99mTc-MIBI. If the radioisotopic method shows a functional image compatible with a carcinoma, a gamma detecting probe is then used to locate the lesion and guide its surgical removal. In this paper, we present the application of the technique in 5 cases and describe the technique and its possibilities. Its advantages are explained in comparison with other methods. The dosimetric values found in the performance of the technique are reported. We consider that detection and radioguided surgery with 99mTc-MIBI in the diagnosis and treatment of occult breast cancer adds an effective tool and means progress in the approach to this disease.

Objective: To review the literature and analyze the main contributions in molecular markers in renal adenocarcinoma., Methods: We reviewed the literature over the last 10 years on molecular markers in renal adenocarcinoma (Medline 1991-2001). Outstanding papers published before 1991, included in the references of the selected articles, were also reviewed., Results: A large number of biomolecular markers have been studied in renal adenocarcinoma with results that are often contradictory. Some proteins have been associated with different histopathological parameters and with tumor prognosis, although their clinical importance has yet to be established., Conclusions: Although the traditional prognostic factors, such as tumor grade and stage, provide important information on the outcome of renal adenocarcinoma, they are insufficient to predict the clinical behavior of this tumor type with absolute certainty. The foregoing has prompted the study of a variety of biomolecular markers that might predict the biological behavior of the tumor and identify the patients at a higher risk for tumor recurrence or death from the tumor. Despite the promising results obtained with biomolecular markers in renal adenocarcinoma, further studies are warranted to determine the prognostic value of these markers.

Prostatic metastases in the nose and paranasal sinuses are rare. Less than 100 cases have been reported in the literature. Kidney are the commonest site of primary tumour, followed by lung and breast. Only 10 cases have previously been reported in the world literature. Prostatic metastases have been mainly reported in the sphenoid sinus. This paper reports one case of metastases of prostatic carcinoma in the fronto-ethmoid sinus in a 72 years old male. The clinical picture includes acute fronto-ethmoid right sinusitis, severe exophthalmos and chemosis. The CT scan showed extensive soft tissue filling the maxillary, ethmoid cells, sphenoid and frontal right sinuses, with subdural abscess. Biopsies from the fronto-ethmoid mass showed infiltration by adenocarcinoma with positive immunostaining for prostatic specific antigen. We also review the literature about metastases involving the nose and paranasal sinuses.

Unlabelled: We found that the seroprevalence in Cancer Institute of H. pylori infection was significantly more frequent in gastric cancer than in age- and gender-matched controls. This study suggested an epidemiological link between H. pylori infection and gastric cancer. H. pylori exhibits a complex system of enzymes which serve a range of functions. Toxic effects are produced by urease (UR), phospholipase (PL) and alcohol dehydrogenase (ADH). We embarked on an exploration of the enzyme activities of H. pylori infected patients using a TLC-autoradioluminography. This method has a wide dynamic range and could offer an analytical technique for studying a radioactive compound and its enzymes in H. pylori infected mucosa. Biopsies samples taken from 21 gastric cancer patients and 95 controls were studied. Although high activity of UR indicates well the presence of H. pylori impairment, activities of ADH and PL reflects more the chronicity of mucosal damage in both groups. Clearly, the enzyme profile showed in our study reflects the "physiological" adaptations behind chronic injured mucosal changes but its relation to gastric cancer and H. pylori needs further study. There is an urgent need to understand the carcinogenesis process using animal models. We performed previous study for to explore the effect of H. pylori infection on N- methyl-N-nitrosourea-induced (MNU) gastric carcinogenesis in mice C57BL/6 mice were administered broth culture of H. pylori and given MNU in drinking water. In terms of the incidence of neoplasms development was increase in the MNU group pre-infected with H. pylori. That findings showed that C57BL/6 mice-infected model is well suited for investigating the bacteria promoter effect in the gastric carcinogenesis. Finally another rodent model study (still in process) showed rapid development of hyperplastic gastritis with gastric erosions in H. pylori-infected MTH1 knockout mice. We sought to further evaluate MTH1 knockout mice as potential test animal for carcinogenesis., Conclusion: It is suggested that H. pylori infection is an important risk factor for the development of gastric cancer. The possibility that this organism acts etiologically, exerting its effect over long period of time, is biologically plausible. However, the role of H. pylori per se in that process is still a matter of discussion. The various enzymes of H. pylori discussed in this paper support colonization, and are perhaps important for epithelial damage, they could contribute to the stimulation and modulation of the chronic inflammatory response, but its relation to gastric cancer and H. pylori needs further study. Finally H. pylori in C57BL/6 and knockout mice showed excellent colonization at two months and six months after infection there was adenomatous, hyperplastic and ulcerative changes. Those findings showed that both mice-infected models are well suited for investigating the bacteria promoter effect in the gastric carcinogenesis.

Human Papillomavirus (HPV), placebo clinical trial particularly types 16 and 18, are considered human carcinogens since an etiological association has been demonstrated between these viruses and the development of cervical cancer. While the viral role in squamous carcinoma has been largely studied, the information available on adenocarcinoma is scarce, partly because of its lower frequency. In this paper we investigated the presence of HPV types and intratype variants in adenocarcinomas of the cervix. A total of 23 archive samples, fixed and paraffin embedded biopsies, were included. The detection and viral typing was performed by generic PCR and subsequent single stranded conformational polymorphism analysis (SSCP). Genetic variability was investigated in a 450 bp-fragment corresponding to L1 gene by post-PCR direct sequencing. We detected 11 HPV 16 positive samples (9 prototypes and 2 variants: 1 European and 1 Asiatic-American), 10 HPV 18 (9 prototypes and 1 European variant), 1 HPV 31 and 1 negative. The high risk HPV association with this neoplasia was confirmed with a high prevalence (43%) of HPV 18, (but) without predominance over the other types as previously published. The demonstrated variability in L1 protein epitopes originated aminoacidic changes which could have implications on the immune response and therefore should be considered in a vaccine design.

This paper analyzes the influence of perioperative transfusion on survival after lung cancer surgery. Between January 1991 and December 1995, we enrolled 405 patients, 196 of whom received transfusions and 209 of whom did not. Follow-up extended to December 1997. Excluded were patients undergoing exploratory thoracotomy (n = 92), those who died during the postoperative period (n = 19) and those lost to follow-up (n = 13). The final number of patients in the study was 281 (136 who received transfusions and 145 who did not). We analyzed age, sex, general clinical status measured on the Eastern Cooperative Oncology Group (ECOG) scale, histological type and TNM staging. Single and multiple variable analyses were performed. At the end of the study 158 patients were alive and 123 had died. Transfusions were used more often in pneumonectomies (p < 0.001) and in patients with an ECOG score of 2 (p < 0.01). Survival at 36 and 60 months, calculated using the Kaplan-Meier method was 52% and 30%, respectively, for those who had received transfusions, and 53% and 49%, respectively, for those who had not. The differences were not statistically significant (p > 0.1). Multivariant analysis failed to demonstrate an influence of transfusion on survival (relative risk of 1.08; 95% confidence interval 0.72-1.61; p > 0.1). We conclude that there is no negative prognostic effect of perioperative transfusion.

Incidence of prostate disease has seen a sudden boost over the last few years as a result of an increase in male life expectancy. Prostate carcinoma is the third most common cause of cancer mortality in Spain. Post-mortem studies reveal that this is the most prevalent neoplasia in the elderly. 30% of all males over 50 years could host malignant cells in their prostate, although only 20% of these neoplasias have clinical manifestations. Prostate carcinoma expansion occurs by local spreading, as well as lymph and blood dissemination. Local spreading to the urethra, bladder neck, trigonous and seminal vesicles is frequent. Lymph dissemination to obturating, hypogastric, iliac, presacral and paraaortic nodes is a major path for metastasis. Bone metastasis with increased acid phosphatase is the most illustrative sign of prostate adenocarcinoma expansion. Visceral metastasis occur more frequently in lungs, liver and renal glands. There is a 0.3% likelihood of skin metastasis from prostate adenocarcinoma. Considering the rareness of skin metastasis from prostate adenocarcinoma, the case reported in the present paper, first evidence of a prostate carcinoma, is even more exceptional.

The association of a carcinoid tumour with non-endocrine urologic neoplasms is an infrequent finding. This paper contributes one case of multiple primary neoplasm where a prostatic adenocarcinoma coexists with an intestinal carcinoid tumour in a 63-year old asymptomatic patient. Diagnosis of prostate cancer was achieved during a screening for this conditions whereas the intestinal carcinoid tumour was found in the extension study.

Objective: Radical prostatectomy (RP) is an elective therapeutical procedure for localized prostate cancer. The paper describes the critical analysis of our 10-year series., Material and Methods: A total of 216 RP have been performed between June 1986 and December 1996 (60 of them in the last year); with the purpose of securing a minimum follow-up of 4 months, the 204 procedures performed up to October 1996 were studied. Mean age was 64.9 years and PSA median 10.8 ng/ml. Intraglandular clinical stage was found in 192 cases versus 12 cases extraglandular. Up to the end of 1993 Walsh's technique with erectors' preservation was being used although the poor results obtained with regard to potency as well as the existence of positive borders have compelled us to perform the standard extracapsular technique since beginning of 1994., Results: Mean follow-up in our series has been 29.62 months. Post-operative complications reached 29.9%, anastomosis fistula (21 cases) among the early ones and anastomosis stenosis (16 cases) among the late ones. 82.04% patients have total continence or minimal incontinence, the percentage of obstruction being 3.58%. Total impotence is estimated at 92.77%. One patient (0.49%) died in the immediate post-operative. Understaging was observed in 36.7%. 84 patients had extracapsular disease. Our percentage of positive surgical borders is of around 43.13%. Progression has been seen in 47 of 204 patients (23.03%): 8 local relapses, 12 metastasis, 3 with both conditions and 24 biological progression. Progression has been related to pathological stage, pre-operative PSA and Gleason's sum of the specimen. Difference was statistically significant. Overall survival at 1 and 5 years is 99.2% and 95.5% respectively while tumour specific survival is 97.8% and 75.8% at 1 and 5 years., Conclusions: RP is a surgery with minimal mortality but noticeable morbidity (incontinence 14.35%; impotence 92.77%; other complications from surgical technique 29.9%). Our clinical understaging is of around 36.7%. Progression is related to the specimen's pathological stage, and pre-operative PSA and Gleason. Our overall survival at 1 and 5 years is 99.2% and 95.5% respectively while tumour specific survival is 97.8% and 75.8%.

Objectives: In 30-40% patients, prostate adenocarcinoma is diagnosed already in the metastatic phase, a percentage that will depend on the number of patients with localized cancer that we are unable to detect. Hormonal suppression is the most widely accepted therapeutical option, although there are doubts on the value of rescue treatment after the hormone-refractive stage. This paper analyses those parameters as well as the main prognostic factors in a series of 135 patients with metastatic prostate cancer at diagnosis., Material and Methods: Between 1983 and 1996, 414 patients were diagnosed with prostate adenocarcinoma in the Urology Unit. Móstoles Hospital, 135 of which (32.6%) were metastatic at the time of diagnosis and were managed as follows: 113 (84%) were treated with maximum androgenic blockade (MAB). 13 (9.6%) with orchiectomy and antiandrogens, 5 (3.7%) with various treatments, and only 4 received symptomatic treatment. Of those treated with MAB, 97 (72%) continued treatment after the hormone-refractive stage and 16 (12%) were given stramustine phosphate instead of the antiandrogen. Response monitoring was done basically by means of serial PSA determination. The parameters analyzed included survival and the following potential prognostic factors: age, performance status, metastatic bone pain, tumour diagnosis based on number of metastasis, prior PSA level, Gleason, local stage, M1 type at diagnosis based on the 1992 TNM classification, and response to the various treatment applied., Results: Mean age: 72 years. Over an average of 25 (0-127) months, 80 (59%) patients have died; mean follow-up of patients alive at end of study: 24 months (3-111). Lost to follow-up: 6 patients (4.4%). Up to 1991, the proportion of patients with metastasis was 48%; since 1992, 24%. Percentage of patients diagnosed due to clinical manifestations of the metastasis (25 patients) over these two periods increased, mean age decreased and the proportion of patients with highly aggressive tumours increased. Mean overall survival, 26 months: influential prognostic factors: diagnosis due to metastasis and Gleason greater than 7; very poor prognosis for those receiving no hormonal therapy, with no differences between drug versus surgical treatment. Tumour-dependent mean survival, 32 months; influential prognostic factors: performance status, metastatic bone pain, diagnosis due to metastasis and Gleason greater than 7; very poor prognosis for those receiving no hormonal therapy. Progression-free interval, 19 months; influential prognostic factors: metastatic bone pain, PSA higher or lower than 90. Gleason greater than 7 and local stage: no differences between treatments. Mean survival after progression, 6 months; influential prognostic factors: diagnosis due to metastasis, M1b versus M1c patients: increased survival in patients rescued with stramustine phosphate., Conclusions: The proportion of prostate adenocarcinomas with metastasis at diagnosis shows a trend to decrease, although the percentage of patients who are diagnosed by the sings and symptoms of their metastasis is increasing. These patients should be treated with pharmacological or surgical hormone-suppression. Rescue treatment with stramustine phosphate prolongs survival. Influential prognostic factors: Gleason greater than 7, metastatic bone pain, tumour extent and previous PSA.

We have developed an experimental model in which the administration of progestins induces mammary tumors in female virgin BALB/c mice. In this paper we review the morphological and biological features of progestin-induced tumors, such as estrogen receptor (ER) and progesterone receptor (PR) patterns of expression, hormone dependence and epidermal growth factor receptors (EGF-R) we also examine our data concerning the systemic effects of medroxyprogesterone acetate (MPA) as regards its stimulating EGF synthesis in salivary glands and its subsequent increase in serum. This growth factor seems to play an important role in the induction of mammary tumors. Direct MPA proliferative effects mediated by PR were demonstrated using primary cultures of progestin-dependent (PD) mammary tumors. Antiprogestins inhibited cell growth beyond control values, suggesting that PR are involved in cell proliferation even in the absence of the ligand. Progesterone-independent (PI) tumors expressing high levels of PR and ER are also inhibited by estrogen or antiprogestin treatment, suggesting that PR are involved in the control of autonomous tumor growth. Estrogen-resistant variants may be selected which may revert to an estrogen-sensitive phenotype after several transplants in untreated mice. The similarities between the tumors obtained with this model and human breast cancer as regards morphological features, evolution and the regulation of growth control converts this model into a useful tool to explore the mechanisms related with acquisition of hormone independence and autonomous tumor growth.

Cardiac tamponade (CT) and Carcinomatous lymphangitis (CL) association as an initial clinical presentation of a neoplasm is very uncommon, creating diagnosis difficulties in the patient first evaluation. This paper reports one case of a male who was admitted in Emergency Department with clinical and radiological findings of heart failure. Following studies showed CT and CL secondary to a bronchial adenocarcinoma. Differential diagnosis is really important for its associated therapeutic implications because of the CT hemodynamic worsening situation due to the diuretic and vasodilators used in the treatment of heart failure. An echocardiography should be done because it is very useful for the initial evaluation of a heart failure of obscure origin.

The present paper reports a case of metastasis of renal adenocarcinoma in the frontal sinus in absence of symptoms related to the primary localization. The patient's advanced age and the extent of the tumor contraindicated any treatment and the decrease occurred six months after the diagnosis was reached. The authors point out that before an expansive lesion of nasal cavity and paranasal sinuses whose cytological examination is negative for squamous carcinoma, a metastasis from a renal or genito-urinary carcinoma should be suspected.

Presentation of one case of an exceptional association in the same renal unit of a hydatid cyst and an adenocarcinoma, in a female patient who arrived to the emergency service with a picture of haematuria and lower back pain. The paper discusses the diagnostic complications posed by the large central necrotic component of the tumour, the adjacent position of both lesions and, basically, the initial intention of performing conservative surgery after it was demonstrated that the patient had mild renal insufficiency and simple cysts in the other kidney. In the end, faced with the perioperative finding of a neoplastic-like mass, radical surgery was performed. Analysis of the diagnostic and therapeutical difficulties with complex cystic masses in general.

Endometrial Carcinoma is an uncommon intraductal prostatic tumour, the origin (either from prostatic epithelium or Müellerian) and management (traditional hormonal therapy vs. progestagens) of which has been the subject of vigorous debate. Currently and with the help of the immunohistochemical techniques its origin has finally been confirmed as being prostatic, thus justifying the use of the traditional hormonal therapy applied in prostate acinous carcinoma. The paper contributes one case of Endometrial Carcinoma confirmed by immunohistochemical techniques, as well as a review of the main landmarks in the study of these tumours.

Augmentation and substitution erocystoplastias are currently widely accepted techniques for the treatment of several benign and malignant diseases. Appearance of neoplasia on the various gut segments used after a latency period ranging from 5 to 25 years following initial surgery has been described. The paper presents one case of metastatic colon adenocarcinoma initially located in the region of ureteral reimplantation, in a patient with augmentation cecocystoplastia performed as a result of vesical retraction secondary to genitourinary tuberculosis. Appearance of this type of neoplasia in an increasing population, quite often young, compels the urologist to keep a tight watch. Endoscopic monitoring of the new bladder is the most effective diagnostic procedure. A once-a-year endoscopy after an interval as yet not definitely established, but which could be around 10 years after initial enterocystoplastia, seems advisable at least in cases at higher risk.

The renal adenocarcinoma is not a frequent tumour within the scope of multiple neoplasias, at least in the clinical series. Conversely, it appears at a higher relative rate in the post-mortem series. This paper submits a review of renal adenocarcinoma associated in life to other malignant neoplasias, enumerating their major clinical and epidemiological data. Also, it reviews the literature with regard to frequency and etiology, applying the data to our series. The paper concludes that hypernephroma is not a tumour frequently associated with others in life, given its tendency to be secondary to other primary ones, therefore its development depending on survival to the initial tumour. It also emphasizes the need for adequate anamnesis aimed to detect multi-cancer syndromes and the etiology of multiple neoplasias. Further studies are needed to understand the scope of multiple neoplasias and their relative risk.

Presentation of three cases of haemodialysis patients with acquired cystic renal disease (ACRD) who, over the course of their illness, developed clear cells renal carcinoma. The paper emphasizes the common association of these two entities and the need to consider ACRD cases as patients at high risk of developing renal neoplasia.

It has been reported that exceptional association exists between primary colon cancer and hypernephroma. In this paper we are reporting a case of a male patient carrying an hypernephroma synchronous with a proximal colonic adenocarcinoma in addition to a second adenocarcinoma, growing on a tubular adenoma, nearly of first. These findings get seen as partially coincidental with some features of the cancer family syndrome (Lynch syndrome II), and we have considered that genetics conditions, like those of Lynch syndrome II, could to explain some multiple neoplasms in patients carrying then.

The age of monoclonal antibodies arose with the papers by Köhler and Milstein in 1975. By means of a fusion between a neoplastic cell with one which produced a specific antibody they obtained a hybrid or clonal cell. Five years later, Nadler et al issued the first report of a patient with lymphoma treated with monoclonal antibodies. After the first announcement, diverse research centers have reported the clinical results obtained in various neoplasias treated with radioactive monoclonal antibodies directed against antigens associated with neoplasias, as well as non-specific tumoral antigens, including lymphomas, melanomas and cancers of the colon, ovary and breast.

In this paper we analyzed 5,401 upper G.I. endoscopies performed in a period of 5 years (1985-89), in the Gastroenterology Service at Hospital Jesús Yerena, in Caracas, Venezuela. We found 53 cases of stomach cancer, only 2 of them were early gastric cancer. We studied personal and epidemiological data, symptoms, place of the lesion, treatment, surgical mortality, macroscopic morphology and histopathology. We discuss the results concluding that: cancer of the stomach is a prevalent disease in our Hospital; that fibrogastroscopy is a very good diagnostic procedure; that we must organize a Program of Early Detection for this disease and that we should improve the Oncological Register.

Renal adenocarcinomas are tumours which sometimes tend to remain clinically silent, and initially become evident through distant metastasis. This paper presents the case of a 54 year-old patient whose initial clinical evidence was parotid metastasis from kidney clear cells adenocarcinoma. The patient had a metastasis and renal tumour exeresis with application of supplementary chemotherapy and immunotherapy, presenting early pulmonary metastasis which remains currently unchangeable. Some comments apropos of distant metastasis, its prognosis and regression in renal tumours are made.

This paper presents on case of adenocarcinoma at the site of colostomy in a patient treated by abdominoperineal amputation five years earlier due to rectal cancer. The case raised the doubt as to whether the carcinoma represented a late, local recurrence or a second metachronic neoplasia. The most frequent location and pathogenesis of each were analyzed. The role of follow-up of these patients in detecting cases such as the one presented here are discussed.

This paper present the case of a man 72 year old with secondary penis cancer, as a late manifestation of a earlier well differentiated prostate focus, identified by P.A.A.F., which determined the rarity of the presentation and the choice of diagnostic method by puncture-aspiration with a thin needle. Treatment is very complex and neither radiotherapy nor estrogens therapy produced satisfactory results, leaving de choice of total penectomy only for those cases with intractable pain and if there is no pelvic extension.

Primary or metastatic malignancies can be originated either in the bone or in the maxillary sinus. Both locations as primary site occur seldom and are exceptionally seen as metastatic growths especially inside the maxillary sinus. The paper reports a metastatic carcinoma of the kidney in the upper maxillary. Survey of the literature and assessment of the prognosis in those patients.

Cancer of ampulla of Vater is a infrequent tumor which was a much better prognosis after radical treatment than cancer of the pancreas. In this paper, 25 patients were studied, with a mean age of 59 years and a slight male predominance. The most frequent symptoms were related to jaundice and weight loss. The correct preoperative diagnosis was only reached in 54.16% of the patients, endoscopic retrograde cholangiopancreatography being the best diagnostic method, together with ?CTPH. We emphasize the difficulty of reaching a diagnosis and the variable results of both pre- and peroperative biopsy. The results of surgical treatment (9 Whipple operations, 7 ampullectomies and 7 bypass operations) are evaluated, showing that duodenopancreatectomy is the most effective therapy, although we had only one 5-year survival, 11.1% versus 0% for ampullectomy, which is an operation that carriers an elevated recurrence rate (greater than 50%). The mortality derived from Whipple's operation was 22.2%, and from local excision, 14.3%. The rate of complications was 55.5% after cephalic duodenopancreatectomy and null after ampullectomy. In view of these results, we think that the most appropriate therapeutic approach to ampulloma is the Whipple operation, and that ampullectomy should be reserved for those patients in poor general condition with small tumors, and that bypass operations should be used when the tumor is not resectable.

A concomitant epithelial and stromal tumor in stomach is unusual in the literature. The purpose of this paper is to report the case and it's therapeutic management. A 72 year old black male patient , which upper digestive endoscopy showed a gastric neoplasm (Borrmann III) at incisura angularis and the biopsy revealed adenocarcinoma. A subtotal gastrectomy with D2 limphadenectomy and Roux-en-Y reconstruction was performed. The histopathology studies confirmed an adenocarcinoma and a gastric stromal tumor, whose immunohistochemical exam was compatible to GIST. Seventeen months after surgery, a computadorized tomography revealed a retrogastric tumor and laparotomy was indicated to remove the lesion.