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To evaluate the indications and histology of our series of orchiectomies, analysing the results by patient's age.We included the orchiectomies realized in our hospital between 2005 and 2020 in patients older than 18 years. We estimated demographic data, indications, histology and effectiveness of testicular ultrasound by three groups of age.We included 489 orchiectomies, which 364 (74%) belonged to Group A (patients between 18-50 years), 59 (12%) to Group B (50-70 years) and 66 (14%) to Group C (older than 70 years). In Group A, 284 (78%) orchiectomies were indicated due to malignancy suspect. In 91.9% cases (261) malign neoplasm was confirmed at final histology and 253 (89%) were germinal cells. Testicular ultrasound had a positive predictive value (PPV) of 90% in this group. In Group B, 34 (57%) orchiectomies were indicated because of malignancy suspect. At final histologic analysis, 25/34 (73.5%) confirmed malign neoplasm. Ultrasound had a PPV of 68%. In Group C, orchiepididymitis was the main cause of testicular removal with 30 cases (45,5%). From the 20 cases (30.3%) with suspicion of malignancy, only 6 had confirmed malign histology. Testicular ultrasound PPV for malignancy was 31%.In patients younger than 70 years the main orchiectomy's indication was suspect of malignancy and in older than 70, testicular inflammation. The germinal neoplasm was the predominant histology in younger than 70 years. In older than that, malignancy was infrequent. The positive predictive value of testicular ultrasound for malignancy decreased with patient's age. In patients older than 50 years proper image diagnosis to assess malignancy should be considered before orchiectomy is done.

Resumen La resonancia magnetica multiparametrica (RMmp) prostatica ha tenido recientemente un extenso desarrollo, convirtiendose en una herramienta clave en el diagnostico y la toma de decisiones terapeuticas en relacion al carcinoma prostatico (CaP). El rapido desarrollo tecnologico, asi como de lectura (PIRADS V2), exigen una permanente actualizacion del conocimiento en esta area. El objetivo de este articulo es presentar una revision actualizada sobre los aspectos tecnicos, los modelos de lectura y las indicaciones de la RMmp prostatica en relacion al CaP, en el marco de una vision multidisciplinaria. Actualmente esta establecida la utilidad de la RMmp ante un antigeno especifico de prostata elevado y una biopsia prostatica previa negativa; para estadificacion tumoral; en la evaluacion de candidatos a vigilancia activa; en la planificacion de tratamientos focales y para la evaluacion de la recurrencia tumoral. Otras indicaciones, como su uso en pacientes con sospecha de CaP pero sin biopsia previa, aunque se realizan en algunos centros, aun requieren una exhaustiva valoracion coste-beneficio para extender su empleo.

Prostatic multi-parametric magnetic resonance imaging (MP-MRI) has recently had a wide development becoming a key tool in the diagnostic and therapeutic decisions in prostate cancer (Pca). The fast development both in technology and in reading (PIRADS V2) requires a continuous updating of knowledge within this area. The aim of this article is to present an updated revision of technical aspects, reading patterns and prostatic MP-MRI in Pca, with a multidisciplinary approach. Currently guidelines establish the use of the MP-MRI when there is a high PSA and a negative prostatic biopsy; tumor staging; evaluation in candidates to active surveillance; focal treatments plans and tumoral recurrence evaluation. Although it is used in other indications in some centers, like its use in patients suspicious of Pca but with no previous biopsy, there is still the need of a cost/benefit assessment for its use to be wider.

Prostatic multi-parametric magnetic resonance imaging (MP-MRI) has recently had a wide development becoming a key tool in the diagnostic and therapeutic decisions in prostate cancer (Pca). The fast development both in technology and in reading (PIRADS V2) requires a continuous updating of knowledge within this area. The aim of this article is to present an updated revision of technical aspects, reading patterns and prostatic MP-MRI in Pca, with a multidisciplinary approach. Currently guidelines establish the use of the MP-MRI when there is a high PSA and a negative prostatic biopsy; tumor staging; evaluation in candidates to active surveillance; focal treatments plans and tumoral recurrence evaluation. Although it is used in other indications in some centers, like its use in patients suspicious of Pca but with no previous biopsy, there is still the need of a cost/benefit assessment for its use to be wider.

Animal models have shown that erectile dysfunction is associated with adipocyte accumulation under tunica albugínea, which could be involved in venous leakage and loss of penile rigidity. In the current sudy, we compared the histology of the penile sub-albuginean region of drug-refractory erectile dysfunction patients undergoing penile prosthesis implantation with potent patients with Peyronie's disease undergoing curvature correction procedures.Seventeen refractory erectile dysfunction patients and fourteen potent patients with Peyronie's disease were recruited. Sub-albuginean tissue samples were taken in each surgery. An expert uropathologist analysed each section. A bivariate analysis was performed. Multivariate logistic regression was used to calculate adjusted odds ratios; P value.05 was considered significant.Eleven patients (11/17) in the case group presented cavernous fat cell accumulation, while only one patient (1/14) in the control group presented this finding (P.05). Adjusted odds ratio for erectile dysfunction was 40.72; 95% CI 2.28-727.29 (P=.012).Different studies have shown that androgen disruption could be involved in penile structural changes, leading to trabecular smooth muscle apoptosis and trans or de-differentiation into adipocytes. This is the first prospective study in humans to report an association between erectile dysfunction and sub-albuginean adipocyte accumulation. Venous leakage secondary to this phenomenon could be a factor in the pathophysiology of erectile dysfunction, especially in patients that do not respond to medical therapy.

Objetivo: revisar las características morfológicas del infarto testicular segmentario, incidiendo en el diagnóstico diferencial que clínica y radiológicamente plantea con un tumor testicular. Material y métodos: revisión retrospectiva de los casos con diagnóstico anatomopatológico de infarto testicular segmentario diagnosticados y tratados en nuestro centro. En los casos seleccionados se revisaron las laminillas histológicas y se recogieron las características clínicas y radiológicas. Resultados: se localizaron 6 casos con las siguientes características clinicopatológicas: una media de edad de 42 años, afectando con la misma frecuencia al teste derecho y al izquierdo, de causa idiopática o con antecedentes traumáticos o inflamatorios y con diagnóstico histológico de infarto segmentario, ya sea agudo o crónico (en dos de ellos). Común a todos ellos es la sospecha clínica de tumor testicular. Conclusión: el infarto testicular segmentario es una causa de pseudotumor testicular. Aunque infrecuente, debe considerarse en el diagnóstico diferencial clínico de las masas testiculares para evitar orquiectomías innecesarias. Objective: To review the morphologic features of the segmental infarct of testicle with special insistence in the differential diagnosis with a testicular tumor. Material and methods: Retrospective revision of the cases with pathologic diagnostic of segmental infarct of testicle diagnosed and treated in our institution. In the selected cases, we review the histological slides and we collected the clinical and radiological features. Results: We reported 6 cases with the following clinic-pathological features: the average age was 42 years old, both right and left testicles were affected with the same frequency, and the aetiology was idiopathic, trauma or inflammation. All of them with pathological diagnosis of segmental infarct of testicle, either acute or chronic, and in all of them a testicular tumor was suspected. Conclusion: Segmental infarct of testicle is an unfrequent cause of testicular pseudotumor. It must be considered in the clinical differential diagnostic of testicular masses in order to avoid unnecessary orchiectomies.

Aims: To survey current European practices in handling and reporting of radical prostatectomy (RP) specimens. Methods and results: A European Network of Uropathology (ENUP) was organized for the dissemination of information, survey studies and research collaborations. Contact data of uropathologists were collected from 321 pathology laboratories in 15 West European countries. In the first ENUP survey, 67.6% (217/321) of the members replied to a web-based questionnaire. Some practices were adopted by a large majority, e.g. inking of the specimen (96.6%), Gleason grading (99.5%), stratifying extraprostatic extension (EPE) according to extent (88.2%), reporting TNM stage (88.6%) and reporting location of positive margins (98%). As many as 71.6% of respondents always embedded the entire prostate and only 10.8% always practised partial embedding. Whole mounts were routinely used by 37.5% and standard blocks by 55.5%. Among areas with variable routines were methods to define focal versus extensive EPE and methods to quantify margin positivity, probably reflecting that the optimal method has yet to be determined. Conclusions: Some practices are almost universally adopted in Europe, whereas others still need to be standardized. The results of the study may be helpful when judging what recommendations are reasonable to issue.

Resumen El componente quistico del cancer renal (CR) aparece en el estudio radiologico y queda consolidado con el examen anatomopatologico. El concepto “cancer renal quistico” o “tumor renal quistico” es de uso habitual y comprende una serie de entidades que van desde los CR con patron de crecimiento quistico a aquellos que poseen cavidades pseudoquisticas o se hallan imbricados en cualquiera de las enfermedades renales que presentan quistes renales. Diversas publicaciones utilizan de forma indistinta el calificativo “quistico” sin esperar al estudio anatomopatologico, provocando confusion en la terminologia. La gran variabilidad en la forma de presentacion tanto del CR como de las enfermedades quisticas renales produce distintas formas de presentacion radiologica en que se mezclan areas solidas y otras de contenido liquido, aunque solo el examen patologico podra afirmar que se trata de un CR quistico genuino. Solo el CR con patron de crecimiento quistico y el carcinoma multilocular quistico pueden ser llamados con propiedad tumores renales quisticos. Para el resto de entidades, en especial durante el estudio iconografico, es mas adecuado utilizar expresiones no concluyentes como “masa renal de configuracion quistica” o “tumor renal de aspecto quistico”

For many years, the detection of prostate cancer (PC) and the management of its therapy have been based primarily on prostate-specific antigen, rectal examination and prostate biopsy. However, these parameters have known limitations. Multiparametric magnetic resonance imaging (mpMRI) for prostate cancer has undergone extensive development in recent years, providing morphological and functional information. The aim of this study is to present an updated review of the scope and limitations of prostatic mpMRI for PC, in the framework of a multidisciplinary vision.We conducted a literature review (in PubMed) of articles referencing "mpMRI/staging/ PC/detection/active surveillance/therapy planning/post-therapy". We included 4 systematic reviews and other articles published in high impact-factor journals within the field of radiology and urology.MpMRI provides morphological and functional information concerning PC. This information is integrated into the Prostate Imaging Report and Date System, classifying the probability of clinically significant carcinoma on a scale from 1 to 5. The usefulness of mpMRI is currently being established for patients with high prostate-specific antigen levels and prior negative prostate biopsy; tumour staging in selected cases; assessment of patients who are candidates for active surveillance; the planning of focal treatments; and the assessment of tumour persistence and recurrence.MpMRI currently fills a relevant role in the diagnosis and therapeutic decision-making of PC. More widespread use of the technique requires a cost/benefit analysis.

Germ cell tumour is the most frequent malignant tumour type in young men with a 100% rise in the incidence every 20 years. Despite this, the high sensitivity of germ cell tumours to platinum-based chemotherapy, together with radiation and surgical measures, leads to the high cure rate of > or = 99% in early stages and 90%, 75-80% and 50% in advanced disease with 'good', 'intermediate' and 'poor' prognostic criteria (IGCCCG classification), respectively. The high cure rate in patients with limited metastatic disease allows the reduction of overall treatment load, and therefore less acute and long-term toxicity, e.g. organ sparing surgery for specific cases, reduced dose and treatment volume of irradiation or substitution of node dissection by surveillance or adjuvant chemotherapy according to the presence or absence of vascular invasion. Thus, different treatment options according to prognostic factors including histology, stage and patient factors and possibilities of the treating centre as well may be used to define the treatment strategy which is definitively chosen for an individual patient. However, this strategy of reduction of treatment load as well as the treatment itself require very high expertise of the treating physician with careful management and follow-up and thorough cooperation by the patient as well to maintain the high rate for cure. Treatment decisions must be based on the available evidence which has been the basis for this consensus guideline delivering a clear proposal for diagnostic and treatment measures in each stage of gonadal and extragonadal germ cell tumour and individual clinical situations. Since this guideline is based on the highest evidence level available today, a deviation from these proposals should be a rare and justified exception

Resumen Representacion Del "Score" Gleason En La Biopsia Prostatica Del "Score" Gleason Definitivo De La Prostatectomia Radical Introduccion El grado de diferenciacion del adenocarcinoma de prostata por el metodo de Gleason ("score" Gleason) (sG) es un factor pronostico post-prostatectomia radical, por lo que su representatividad en la biopsia es de sumo interes. Patients and methods Doscientos quince pacientes con determinacion del sG en la biopsia y la pieza de prostatectomia, determinado a ciegas por el mismo equipo de tres patologos. Resultados Coincidencia exacta en un 49,7%, infravaloracion en la biopsia en un 38,6% y sobrevaloracion en la biopsia en un 11,6%. El analisis por sG revela: ausencia de casos con sG 2 en la biopsia. No-reproducibilidad en la pieza de los sG 3 y 4 de las biopsias. Coincidencia de los sG 5, 6, 7, 8 y 9 en biopsia del 25%, 45%, 72,7%, 36,8% y 60%, respectivamente (CCglobal 0,32 ± 0,047, p0,0001 en sG de 5 a 8). El patron 4 de Gleason es el menos reconocido o representado en las biopsias (40% de los que se encuentran en la prostatectomia no han sido detectados en la biopsia). Conclusiones La determinacion del grado en la biopsia por el metodo de Gleason tiene una buena correlacion con el de la pieza de prostatectomia. Para mejorar la correspondencia se deben tener en cuenta que los sG 2, 3 y 4 en biopsia no son reproducidos en las prostatectomias y el porcentaje de coincidencias aumenta con el sG, siendo los patrones 4 y 5 los menos reconocidos en la biopsia, por lo que se recomienda cautela en casos de patrones bajos, en especial con escasa representacion de tumor, y una escrupulosa busqueda de los patrones 4 y 5 y reflejarlos, por escasos que sean en la biopsia.

The molecular basis of spermatogenic failure (SpF) is still largely unknown. Accumulating evidence suggests that a series of specific events such as meiosis, are determined at the early stage of spermatogenesis. This study aims to assess the expression profile of pre-meiotic genes of infertile testicular biopsies that might help to define the molecular phenotype associated with human deficiency of sperm production. An accurate quantification of testicular mRNA levels of genes expressed in spermatogonia was carried out by RT-qPCR in individuals showing SpF owing to germ cell maturation defects, Sertoli cell-only syndrome or conserved spermatogenesis. In addition, the gene expression profile of SpF was compared with that of testicular tumour, which is considered to be a severe developmental disease of germ cell differentiation. Protein expression from selected genes was evaluated by immunohistochemistry. Our results indicate that SpF is accompanied by differences in expression of certain genes associated with spermatogonia in the absence of any apparent morphological and/or numerical change in this specific cell type. In SpF testicular samples, we observed down-regulation of genes involved in cell cycle (CCNE1 and POLD1), transcription and post-transcription regulation (DAZL, RBM15 and DICER1), protein degradation (FBXO32 and TM9SF2) and homologous recombination in meiosis (MRE11A and RAD50) which suggests that the expression of these genes is critical for a proper germ cell development. Interestingly, a decrease in the CCNE1, DAZL, RBM15 and STRA8 cellular transcript levels was also observed, suggesting that the gene expression capacity of spermatogonia is altered in SpF contributing to an unsuccessful sperm production. Altogether, these data point to the spermatogenic derangement being already determined at, or arising in, the initial stages of the germ line.

Objective: To investigate the morphological diagnostic criteria and biology of the urinary bladder small cell carcinoma (SCC). Methods: Study of 23 cases of bladd

The great controversy surrounding the treatment of localized prostate cancer is related with its possibilities of radical treatment or active surveillance. The objective of this paper is to analyze the rationale selection among current focal therapy modalities regarding tumor and patient selection.Current articles about advantages and disadvantages on the treatment of localized prostate cancer as well as information about focal therapy regarding tumour selection, characteristics and indications cited in MEDLINE search were reviewed.Focal therapy standardized criteria must be: low risk tumors, PSA10-15, Gleason score ≤ 6, and unilateral presentation all supported by image-guided biopsy and nuclear magnetic resonance (NMR). There are doubts about the suitability of focal therapy in cases of bilateralism or in those with Gleason score 3+4 or PSA15.Focal therapy is an alternative for localized prostate cancer treatment. However, some aspects of their diagnosis and selection criteria should be defined by prospective studies which should provide knowledge about the indication for focal therapy.

Renal cell carcinoma (RCC), although occurring less frequently than prostate and bladder cancer, is actually the most malignant urologic disease, killing >35% of affected patients. Therefore, investigation of the nature of premalignant lesions of the kidney is a relevant issue. Following the most recent histological classification RCC can be subdivided into four categories: conventional RCC; papillary RCC; chromophobe RCC; and collecting duct carcinoma. In contrast to many genitourinary malignancies, premalignant alterations in the kidney are scarcely described. Intratubular epithelial dysplasia has been recognized as the most common precursor of RCC. In analogy to prostatic intraepithelial neoplasia (PIN), the premalignant lesions of the kidney are described as high or low-grade renal intratubular neoplasia. In contrast, precancerous lesions have been described as part of the von Hippel-Lindau syndrome (VHL) where the evolution from a simple cyst to an atypical cyst with epithelial hyperplasia to cystic or solid conventional-type RCC is well documented. Finally, in the genesis of papillary RCC an adenoma-carcinoma sequence has been recognized with specific genetic changes. There are no data on the epidemiology of premalignant lesions of the kidney, but research into the etiology of RCC has been extended substantially. Familial and genetic factors are well documented in VHL disease, in hereditary papillary RCC, in the tuberous sclerosis complex and in familial RCC. Cigarette smoking and obesity are established risk factors for RCC. Hypertension or its medication has also been associated with an increased risk. Among dietary factors an inverse relation between risk and consumption of vegetables and fruit has been found. Occupational exposure to substances such as asbestos and solvents has been linked to an increased risk of RCC. Specific RCC variants have distinctive chromosome alterations and several genes have been implicated in the development of RCC. Loss of material from the 3p chromosome characterizes conventional RCC and the deletion of the VHL suppressor gene plays an important role in the genesis of this RCC variant. In contrast, numerical changes with trisomy of chromosomes 7 and 17 and loss of the sex chromosome are typical changes in papillary tumors, whereas papillary RCC have additional trisomies. Chromophobe RCC is characterized by loss of chromosomes with a combination of monosomies. Less consistent genetic alterations are associated with collecting duct carcinoma. The traditional treatment of RCC is surgery by radical or partial nephrectomy. The latter approach carries a risk of tumor recurrence as a result of unrecognized satellite lesions or premalignant lesions that might have been present at the time of surgery. However, the reported recurrence rates after partial nephrectomy are

Purpose: We identified risk groups in primary superficial bladder cancer according to progression, mortality and recurrence rates.Materials and Methods: The prognostic factors of progression, mortality and recurrence were identified by multivariate analysis in a cohort of 1,529 patients with primary superficial bladder cancer. Risk groups were designed by combining the relative risk of these prognostic factors. We performed survival analysis of progression, tumor mortality and recurrence by risk group using the Kaplan-Meier method. Relative risk in each group was calculated by Cox regression. We present timetables of progression, mortality and recurrence by risk group.Results: Risk groups were classified as low—grade 1 stage Ta disease and a single grade 1 stage T1 tumor, intermediate—multiple grade 1 stage T1 tumors, grade 2 stage Ta disease and a single grade 2 stage T1 tumor, and high—multiple grade 2 stage T1 tumors, grade 3 stages Ta and T1 disease, and any stage disease associated with carcinoma in ...

Resumen Objetivo Hallar un modelo morfologico del desarrollo de la hiperplasia prostatica. Metodos Se estudia la zona de transicion de 60 pacientes (30 con obstruccion infravesical, y otros 30 sin sintomas obstructivos), cuantificandose la superficie de dicha zona, el numero de nodulos estromales puros y glandulo-estromales, el area nodular de cada uno de ellos, y el area no nodular de la zona de transicion, correlacionando cada uno de estos parametros con la edad, de acuerdo a la situacion clinica. Resultados La mayor area de la zona de transicion se observa en los pacientes obstruidos, que es de 1376,83 ± 408,17 mm2 frente a los 321,39 ± 151,49 mm2 en los asintomaticos, y, a expensas, sobre todo, al incremento del numero de nodulos glandulo-estromales (17 vs 2.2), y de su tamano, correlacionandose con la edad (p = 0,03). Tambien hay un moderado incremento del area no nodular. Conclusiones Estos hallazgos sugieren que el inicio de la hiperplasia prostatica puede ser un incremento homogeneo de la zona de transicion, y que en algunos pacientes, probablemente por factores locales, se produce el desarrollo nodular, preferentemente glandulo-estromal, tanto por el aumento del numero de nodulos como de su tamano.

The identification of new subtypes of renal cell carcinoma (RCC) has made it necessary to re-evaluate the current clinical and pathological predictive factors (stage, Fuhrman nuclear grade, necrosis, lymphovascular invasion [LVI] and sarcomatoid component) in these new subtypes. The chromophobe renal cell carcinoma (CRCC) is considered a less aggressive subtype of RCC. The purpose of this article is to evaluate the usefulness of current clinicopathologic predictors of RCC in our series of CRCC.We retrospectively reviewed the clinicopathologic features of 63 patients with CRCC treated with radical nephrectomy. The parameters analyzed were tumor extension with the TNM, grade according to Fuhrman classification, LVI, tumor necrosis, tumor thrombus, surgical margin status, and involvement of the collecting system. The results (disease recurrence) were evaluated by Cox regression model with univariate and multivariate analysis.With a median follow up of 60.2 months (0.37-160.2), 8 (11%) patients had recurrence, with median time to recurrence of 31.7 months (5.37-124.33). In the univariate analysis, TNM extension (p=0.0001), Fuhrman grade III or IV (p=0.031), LVI (p=0.0001) and the presence of positive surgical margins (p=0.0001) were statistically significant variables for recurrence. In the multivariate analysis, only tumor stage was confirmed as an independent predictor of recurrence, pT1 versus pT2 (p=0.02, OR 0.27 95% CI 0.03-0.258) and pT2 versus higher stage (p=0.037, OR 0.173 95% CI 0.033-0.896).The tumor stage predicts aggressiveness in the CCRC. The classification of Fuhrman nuclear grade is not useful for this histological subtype.

On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy, and follow-up of testicular cancer were established.This article is a short version of the EAU testicular cancer guidelines and summarises the main conclusions from the guidelines on the management of testicular cancer.Guidelines were compiled by a multidisciplinary guidelines working group. A systematic review was carried out using Medline and Embase, also taking Cochrane evidence and data from the European Germ Cell Cancer Consensus Group into consideration. A panel of experts weighted the references, and a level of evidence and grade of recommendation were assigned.There is a paucity of literature especially regarding longer term follow-up, and results from a number of ongoing trials are awaited. The choice of treatment centre is of the utmost importance, and treatment in reference centres within clinical trials, especially for poor-prognosis nonseminomatous germ cell tumours, provides better outcomes. For patients with clinical stage I seminoma, based on recently published data on long-term toxicity, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment. The TNM classification 2009 is recommended.These guidelines contain information for the standardised management of patients with testicular cancer based on the latest scientific insights. Cure rates are generally excellent, but because testicular cancer mainly affects men in their third or fourth decade of life, treatment effects on fertility require careful counselling of patients, and treatment must be tailored taking individual circumstances and patient preferences into account.Although testicular cancer has excellent cure rates, the choice of treatment centre is of the utmost importance. Expert centres achieve better results for both early stage testicular cancer (lower relapse rates) and overall survival (higher stages within clinical trials). For patients with clinical stage I seminoma, adjuvant radiotherapy is no longer recommended as first-line adjuvant treatment.