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+A 68 year old male patient with a personal history of TUR of the prostate for benign prostatic hyperplasia in another centre, whose pathological study revealed the presence of a Gleason 6 adenocarcinoma with PSA values within the normal range and who was subsequently treated with radiotherapy with radical intent and is currently in a disease-free interval.
+He consulted for pain in the right groin for more than 2 years, which increased with standing and decreased with decubitus. Diagnosed with a direct right inguinal hernia, he underwent an inguinal herniorrhaphy and correction of a concomitant right hydrocele. At the same time, a mameloned fleshy tumour was observed attached to the upper pole of the testicle, measuring 2 centimetres in diameter. Right radical orchiectomy via the inguinal route and excision of the spermatic cord above the internal inguinal ring was performed. There was no evidence of lymphadenopathy. The anatomopathological study revealed a leiomyosarcoma with positive immunohistochemistry for Actin and Vimentin and negative for Prostate Specific Antigen.
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+The extension study was normal. Complementary radiotherapy was considered. After 9 months he noted the appearance of an outgrowth lesion measuring 3 x 2.5 centimetres in the herniorrhaphy scar which was resected, reporting a recurrence of leiomyosarcoma with increased mitotic activity. She did not receive adjuvant treatment. After 6 months he noticed the appearance of a new nodular lesion on the right flank with progressive increase in size. The C.A.T. showed a nodule that infiltrated the subcutaneous fat and the iliopsoas muscle in depth. The tumour was resected together with fibres of the lesser oblique, transverse muscle and iliopsoas muscle. The pathology report is compatible with infiltration by leiomyosarcoma. At this point, adjuvant therapy with adriamycin and ifosfamide for six cycles was proposed. After 12 months, the patient underwent surgery again for local recurrence, stony to the touch, which trapped arterial and venous vessels in the groin area. The report concludes recurrence of high-grade leiomyosarcoma.
+Magnetic resonance imaging showed an adenopathic inguinal mass with retroperitoneal lymphadenopathy that ruled out any possibility of radical treatment. It was decided to administer second-line chemotherapy with docetaxel and gemcitabine for six cycles. After 8 months of disease-free interval, a new mass appeared in the inguinal region together with pulmonary metastases in the control CAT scan and palliative treatment with adriamycin was decided. Prior to this new recurrence, the patient presented an episode of haematuria, which was confirmed by ultrasound scanning and confirmed by cystoscopy, and showed the existence of an excrescent lesion in the right bladder wall measuring 3 centimetres. The patient rejected the possibility of U.T.R. as he was undergoing chemotherapy and subsequent deterioration of his general condition.
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