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    "textoCompleto" => "To the editor&#58; Contraindicating&#160; the start&#160; of&#160; chronic&#160; dialysis&#160; in&#160; a&#160; patient with&#160; an&#160; advanced&#160; malignant&#160; tumor1 <br></br>may be very difficult if the patient is in a good general condition and symptomfree&#46; An&#160; example&#160; of&#160; a&#160; situation&#160; where this may occur are&#160; patients with carcinoid&#160; tumors&#44;&#160; an&#160; uncommon&#160; condition with a high survival rate despite its high metastatic&#160; capacity&#160; that&#160; grows&#160; slowly and&#160; has&#160; an&#160; indolent&#160; course&#160; in&#160; many cases&#46;2&#44;3 <br></br><br></br>The case of a 72-year-old male patient&#160; in&#160; whom&#160; evidence&#160; of&#160; chronic renal&#160; failure&#160; for&#160; an&#160; unknown&#160; cause <br></br>was&#160; detected&#160; in May&#160; 2006&#160; during&#160; a work-up study for isomorphic macrohematuria&#160; episodes&#160; is&#160; reported&#46;&#160; A <br></br>cystoscopy&#160; and&#160; several&#160; urine&#160; cytologies&#160; showed&#160; no malignancy&#46; The&#160; patient started hemodialysis two months <br></br>later due&#160; to uremic clinical signs&#46; An urological&#160; MRI&#160; performed&#160; a&#160; little later showed right pyelocalycial ectasis with a pelvic filling defect approximately&#160; 2&#46;5&#160; cm&#160; in&#160; diameter&#160; suggesting&#160; a urinary&#160; tract&#160; tumor&#44;&#160; as well&#160; as <br></br>multiple&#160; hepatic&#160; lesions&#46;&#160; FNA of&#160; the liver&#160; showed&#160; carcinoma&#160; consistent with metastasis from a neuroendocrine&#160; tumor&#46; An&#160; oncological&#160; octreotide scan&#44;&#160; performed&#160; in August&#160; 2006&#44;&#160; revealed&#160; scintigraphic&#160; uptake&#160; suggesting lesions with a high density of somatostatin&#160; receptors&#160; in&#160; the&#160; liver&#46; The presence of foci with a high uptake in <br></br>the thoracic study suggested the diagnostic&#160; possibility&#160; that&#160; the&#160; primary tumor was of pulmonary or bronchial <br></br>origin&#160; &#40;fig&#46;&#160; 1&#41;&#44;&#160; but&#160; a&#160; subsequently performed&#160; CT scan&#160; of&#160; the&#160; chest&#160; and abdomen&#160; showed&#160; no&#160; obvious&#160; lesions in&#160; mediastinum&#160; or&#160; lungs&#46;&#160; However&#44; the&#160; patient&#160; was&#160; still&#160; asymptomatic&#44; with a good general condition and tolerating&#160; well&#160; hemodialysis&#160; sessions&#46; The&#160; only&#160; remarkable&#160; findings&#160; were resistance&#160; to&#160; erythropoietin&#160; and&#160; a consequent&#160; trend&#160; to&#160; anemia&#46;&#160; Under the&#160; control&#160; of&#160; the&#160; oncology&#160; department&#44;&#160; patient was&#160; treated with&#160; intramuscular&#160; somatostatin&#160; analogs&#44;&#160; but never had a carcinoid syndrome &#40;episodes&#160; of&#160; flushing&#44;&#160; dyspnea&#44;&#160; diarrhea&#44; or&#160; right&#160; valve&#160; disease&#41;&#46;&#160; Because&#160; of occasional&#160; recurrence&#160; of&#160; hematuria with&#160; discomfort&#160; in&#160; the&#160; right&#160; lumbar area&#160; and based on&#160; the&#160; suspicion of&#160; a non-endocrine&#160; tumor&#160; because&#160; of&#160; the absence of scintigraphic uptake in the octreotide&#160; scan&#44;&#160; a&#160; control&#160; urological MRI was performed half a year later&#46; MRI&#160; showed&#160; persistent&#160; hepatic&#160; lesions mainly in the right lobe&#44; and an infiltrative lesion in the right pyeloureteral&#160; junction&#160; causing&#160; significant dilation&#160; of&#160; the&#160; collecting&#160; system&#46; There was an additional mass that lobulated&#160; the&#160; cortical&#160; contour&#160; of&#160; the same&#160; kidney&#44;&#160; appeared&#160; to&#160; communicate with&#160; the&#160; renal pelvis&#160; lesion&#44; and had a greater axis of 4&#46;2 cm&#46; Based on these&#160; findings&#44;&#160; the&#160; case&#160; was&#160; re-evaluated&#160; by&#160; the&#160; oncology&#160; and&#160; urology departments&#44; and a right nephrectomy was&#160; performed&#46;&#160; The&#160; postoperative course&#160; was&#160; very&#160; torpid&#46;&#160; Transfusion <br></br>of several red cell packs and debridement&#160; of&#160; an&#160; intraabdominal&#160; abscess were&#160; performed&#44;&#160; despite&#160; which&#160; the <br></br>patient died a&#160; few days&#160; later&#46; A renal pathological&#160; study&#160; revealed&#160; a&#160; grade 3-4&#160; renal&#160; cell&#160; carcinoma&#160; with&#160; wide <br></br>necrotic areas and a predominance of eosinophilic&#160; cells&#46; Lymph&#160; nodes&#160; isolated from renal fat and hilum had no <br></br>neoplastic infiltration&#46; <br></br><br></br>Carcinoid&#160; tumors&#160; are&#160; neoplasms originating from cells of the neuroendocrine&#160; system&#46;&#160; Two&#160; thirds&#160; of&#160; these <br></br>tumors are&#160; located&#160; in&#160; the gastrointestinal&#160; tract&#160; &#40;41&#46;8&#37;&#160; in&#160; the small bowel&#44; 27&#46;4&#37;&#160; in&#160; rectum&#44;&#160; and&#160; 8&#46;7&#37;&#160; in&#160; stomach&#41;&#46;3 Pulmonary and bronchial carcinoid tumors have also occurred&#46; Typical&#160; tumors&#160; have well&#160; differentiated <br></br>cells&#160; and&#160; usually&#160; involve&#160; the&#160; hilum&#44; but less common&#44; atypical tumors also occur&#160; in&#160; more&#160; peripheral&#160; locations <br></br>and in older patients&#46;2 Tumors may secrete&#160; hormones&#44;&#160; causing&#160; the&#160; classical carcinoid syndrome&#44; but there are also non-secreting&#160; tumors&#46;&#160; Severity&#160; depends on tumor size and the extent of metastases&#44;&#160; particularly&#160; if&#160; they&#160; occur in&#160; the&#160; liver&#46;&#160; In addition&#160; to conventional&#160; imaging&#160; tests&#44;&#160; scintigraphy&#160; is&#160; essential to study the extent of this neoplasm&#46;3 <br></br><br></br>It is known that carcinoid tumors are sometimes&#160; associated&#160; to&#160; other&#160; tumors&#46; Approximately&#160; 15&#37;&#160; of&#160; carcinoid&#160; tumors arising in the small bowel are associated&#160; to&#160; non-carcinoid&#160; neoplasms&#44; most&#160; of&#160; them&#160; adenocarcinomas&#160; of&#160; the gastrointestinal tract&#46;4 <br></br><br></br>It is noteworthy how&#44; in the case reported&#44;&#160; the&#160; study&#160; of&#160; a&#160; symptom&#160; such as hematuria led us to diagnose a very <br></br>advanced chronic&#160; renal&#160; impairment&#44; a carcinoid&#160; tumor&#44; and&#160; finally&#44; a hypernephroma&#46; It should also be noted that a&#160; metastatizing&#160; tumor&#44;&#160; a&#160; carcinoid tumor&#160; in our&#160; case&#44; may&#160; follow&#160; an&#160; indolent&#160; course&#46;&#160; The&#160; patient&#160; was&#160; in&#160; a good general condition&#44; and his death was&#160; eventually&#160; caused&#160; by&#160; other&#160; reason&#46; The need&#160; for&#160; a&#160; scintigraphic&#160; test such as an oncological octreotide scan is&#160; stressed&#44;&#160; as&#160; the&#160; absence&#160; of&#160; uptake showed&#160; us&#160; that&#160; the&#160; renal&#160; tumor&#160; was not&#160; a&#160; carcinoid&#46;&#160; Moreover&#44;&#160; primary renal carcinoid tumor is extremely infrequent&#46;5 <br></br><br></br>We think that coexistence of a carcinoid&#160; tumor&#160; and&#160; hypernephroma&#160; is&#160; casual&#44;&#160; because&#160; only&#160; another&#160; case&#160; in <br></br>which&#160; a&#160; carcinoid&#160; tumor&#160; in&#160; the&#160; cecal appendix and a renal cell carcinoma coexisted in the same patient was found in the literature&#46;6 <br></br>"
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Carcinoid tumor and hypernephroma coexisting in a patient with chronic renal failure
Tumor carcinoide e hipernefroma: coexistencia en un paciente con insuficiencia renal crónica
Montserrat Picazo Sáncheza, Marc Cuxart Péreza, Ramon Sans Lormana
a Servicio de Nefrología, Hospital de Figueres Figueres Gerona, España,
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    "textoCompleto" => "To the editor&#58; Contraindicating&#160; the start&#160; of&#160; chronic&#160; dialysis&#160; in&#160; a&#160; patient with&#160; an&#160; advanced&#160; malignant&#160; tumor1 <br></br>may be very difficult if the patient is in a good general condition and symptomfree&#46; An&#160; example&#160; of&#160; a&#160; situation&#160; where this may occur are&#160; patients with carcinoid&#160; tumors&#44;&#160; an&#160; uncommon&#160; condition with a high survival rate despite its high metastatic&#160; capacity&#160; that&#160; grows&#160; slowly and&#160; has&#160; an&#160; indolent&#160; course&#160; in&#160; many cases&#46;2&#44;3 <br></br><br></br>The case of a 72-year-old male patient&#160; in&#160; whom&#160; evidence&#160; of&#160; chronic renal&#160; failure&#160; for&#160; an&#160; unknown&#160; cause <br></br>was&#160; detected&#160; in May&#160; 2006&#160; during&#160; a work-up study for isomorphic macrohematuria&#160; episodes&#160; is&#160; reported&#46;&#160; A <br></br>cystoscopy&#160; and&#160; several&#160; urine&#160; cytologies&#160; showed&#160; no malignancy&#46; The&#160; patient started hemodialysis two months <br></br>later due&#160; to uremic clinical signs&#46; An urological&#160; MRI&#160; performed&#160; a&#160; little later showed right pyelocalycial ectasis with a pelvic filling defect approximately&#160; 2&#46;5&#160; cm&#160; in&#160; diameter&#160; suggesting&#160; a urinary&#160; tract&#160; tumor&#44;&#160; as well&#160; as <br></br>multiple&#160; hepatic&#160; lesions&#46;&#160; FNA of&#160; the liver&#160; showed&#160; carcinoma&#160; consistent with metastasis from a neuroendocrine&#160; tumor&#46; An&#160; oncological&#160; octreotide scan&#44;&#160; performed&#160; in August&#160; 2006&#44;&#160; revealed&#160; scintigraphic&#160; uptake&#160; suggesting lesions with a high density of somatostatin&#160; receptors&#160; in&#160; the&#160; liver&#46; The presence of foci with a high uptake in <br></br>the thoracic study suggested the diagnostic&#160; possibility&#160; that&#160; the&#160; primary tumor was of pulmonary or bronchial <br></br>origin&#160; &#40;fig&#46;&#160; 1&#41;&#44;&#160; but&#160; a&#160; subsequently performed&#160; CT scan&#160; of&#160; the&#160; chest&#160; and abdomen&#160; showed&#160; no&#160; obvious&#160; lesions in&#160; mediastinum&#160; or&#160; lungs&#46;&#160; However&#44; the&#160; patient&#160; was&#160; still&#160; asymptomatic&#44; with a good general condition and tolerating&#160; well&#160; hemodialysis&#160; sessions&#46; The&#160; only&#160; remarkable&#160; findings&#160; were resistance&#160; to&#160; erythropoietin&#160; and&#160; a consequent&#160; trend&#160; to&#160; anemia&#46;&#160; Under the&#160; control&#160; of&#160; the&#160; oncology&#160; department&#44;&#160; patient was&#160; treated with&#160; intramuscular&#160; somatostatin&#160; analogs&#44;&#160; but never had a carcinoid syndrome &#40;episodes&#160; of&#160; flushing&#44;&#160; dyspnea&#44;&#160; diarrhea&#44; or&#160; right&#160; valve&#160; disease&#41;&#46;&#160; Because&#160; of occasional&#160; recurrence&#160; of&#160; hematuria with&#160; discomfort&#160; in&#160; the&#160; right&#160; lumbar area&#160; and based on&#160; the&#160; suspicion of&#160; a non-endocrine&#160; tumor&#160; because&#160; of&#160; the absence of scintigraphic uptake in the octreotide&#160; scan&#44;&#160; a&#160; control&#160; urological MRI was performed half a year later&#46; MRI&#160; showed&#160; persistent&#160; hepatic&#160; lesions mainly in the right lobe&#44; and an infiltrative lesion in the right pyeloureteral&#160; junction&#160; causing&#160; significant dilation&#160; of&#160; the&#160; collecting&#160; system&#46; There was an additional mass that lobulated&#160; the&#160; cortical&#160; contour&#160; of&#160; the same&#160; kidney&#44;&#160; appeared&#160; to&#160; communicate with&#160; the&#160; renal pelvis&#160; lesion&#44; and had a greater axis of 4&#46;2 cm&#46; Based on these&#160; findings&#44;&#160; the&#160; case&#160; was&#160; re-evaluated&#160; by&#160; the&#160; oncology&#160; and&#160; urology departments&#44; and a right nephrectomy was&#160; performed&#46;&#160; The&#160; postoperative course&#160; was&#160; very&#160; torpid&#46;&#160; Transfusion <br></br>of several red cell packs and debridement&#160; of&#160; an&#160; intraabdominal&#160; abscess were&#160; performed&#44;&#160; despite&#160; which&#160; the <br></br>patient died a&#160; few days&#160; later&#46; A renal pathological&#160; study&#160; revealed&#160; a&#160; grade 3-4&#160; renal&#160; cell&#160; carcinoma&#160; with&#160; wide <br></br>necrotic areas and a predominance of eosinophilic&#160; cells&#46; Lymph&#160; nodes&#160; isolated from renal fat and hilum had no <br></br>neoplastic infiltration&#46; <br></br><br></br>Carcinoid&#160; tumors&#160; are&#160; neoplasms originating from cells of the neuroendocrine&#160; system&#46;&#160; Two&#160; thirds&#160; of&#160; these <br></br>tumors are&#160; located&#160; in&#160; the gastrointestinal&#160; tract&#160; &#40;41&#46;8&#37;&#160; in&#160; the small bowel&#44; 27&#46;4&#37;&#160; in&#160; rectum&#44;&#160; and&#160; 8&#46;7&#37;&#160; in&#160; stomach&#41;&#46;3 Pulmonary and bronchial carcinoid tumors have also occurred&#46; Typical&#160; tumors&#160; have well&#160; differentiated <br></br>cells&#160; and&#160; usually&#160; involve&#160; the&#160; hilum&#44; but less common&#44; atypical tumors also occur&#160; in&#160; more&#160; peripheral&#160; locations <br></br>and in older patients&#46;2 Tumors may secrete&#160; hormones&#44;&#160; causing&#160; the&#160; classical carcinoid syndrome&#44; but there are also non-secreting&#160; tumors&#46;&#160; Severity&#160; depends on tumor size and the extent of metastases&#44;&#160; particularly&#160; if&#160; they&#160; occur in&#160; the&#160; liver&#46;&#160; In addition&#160; to conventional&#160; imaging&#160; tests&#44;&#160; scintigraphy&#160; is&#160; essential to study the extent of this neoplasm&#46;3 <br></br><br></br>It is known that carcinoid tumors are sometimes&#160; associated&#160; to&#160; other&#160; tumors&#46; Approximately&#160; 15&#37;&#160; of&#160; carcinoid&#160; tumors arising in the small bowel are associated&#160; to&#160; non-carcinoid&#160; neoplasms&#44; most&#160; of&#160; them&#160; adenocarcinomas&#160; of&#160; the gastrointestinal tract&#46;4 <br></br><br></br>It is noteworthy how&#44; in the case reported&#44;&#160; the&#160; study&#160; of&#160; a&#160; symptom&#160; such as hematuria led us to diagnose a very <br></br>advanced chronic&#160; renal&#160; impairment&#44; a carcinoid&#160; tumor&#44; and&#160; finally&#44; a hypernephroma&#46; It should also be noted that a&#160; metastatizing&#160; tumor&#44;&#160; a&#160; carcinoid tumor&#160; in our&#160; case&#44; may&#160; follow&#160; an&#160; indolent&#160; course&#46;&#160; The&#160; patient&#160; was&#160; in&#160; a good general condition&#44; and his death was&#160; eventually&#160; caused&#160; by&#160; other&#160; reason&#46; The need&#160; for&#160; a&#160; scintigraphic&#160; test such as an oncological octreotide scan is&#160; stressed&#44;&#160; as&#160; the&#160; absence&#160; of&#160; uptake showed&#160; us&#160; that&#160; the&#160; renal&#160; tumor&#160; was not&#160; a&#160; carcinoid&#46;&#160; Moreover&#44;&#160; primary renal carcinoid tumor is extremely infrequent&#46;5 <br></br><br></br>We think that coexistence of a carcinoid&#160; tumor&#160; and&#160; hypernephroma&#160; is&#160; casual&#44;&#160; because&#160; only&#160; another&#160; case&#160; in <br></br>which&#160; a&#160; carcinoid&#160; tumor&#160; in&#160; the&#160; cecal appendix and a renal cell carcinoma coexisted in the same patient was found in the literature&#46;6 <br></br>"
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Article information
ISSN: 20132514
Original language: English
DOI:
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2017 December 39 13 52
2017 November 31 12 43
2017 October 39 5 44
2017 September 32 10 42
2017 August 31 14 45
2017 July 28 10 38
2017 June 24 15 39
2017 May 33 17 50
2017 April 33 8 41
2017 March 22 17 39
2017 February 19 5 24
2017 January 22 12 34
2016 December 40 10 50
2016 November 45 4 49
2016 October 70 11 81
2016 September 88 4 92
2016 August 117 2 119
2016 July 122 5 127
2016 June 92 0 92
2016 May 121 0 121
2016 April 60 0 60
2016 March 59 0 59
2016 February 72 0 72
2016 January 77 0 77
2015 December 91 0 91
2015 November 58 0 58
2015 October 64 0 64
2015 September 52 0 52
2015 August 69 0 69
2015 July 73 0 73
2015 June 26 0 26
2015 May 34 0 34
2015 April 7 0 7
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?