Left paratesticular fibrous pseudotumor on the single testis and contribution of imaging in therapeutic management, a case report.

INTRODUCTION AND IMPORTANCE: Paratesticular fibrous pseudotumor is a rare benign tumor. Clinically, it can mimic testicular malignancy, but this lesion results from a reactive proliferation of inflammatory and fibrous tissue. CASE PRESENTATION: A 62-year-old man presented with left scrotal swelling dating back years. A left paratesticular mass is palpated, firm and painless. Ultrasound showed a heterogeneous and hypoechoic lesion in a single left testicle; the right testicle was not found in the scrotum or at the inguinal level. CT scan showed a hypodense left scrotal mass. The scrotal MRI showed the presence of a paraliquid left intrascrotal formation pushing back the left testicle. We performed a scrotal exploration with excision of the paratesticular mass, sparing the left testicle. The definitive pathological diagnosis was reported as paratesticular fibrous pseudotumor. CLINICAL DISCUSSION: Paratesticular Fibrous pseudotumors are a rare tumor with approximately 200 cases reported to date. These lesions constitute 6 % of all paratesticular lesions. Magnetic resonance imaging can give additional information when an ultrasound is inconclusive. The treatment of choice is a scrotal exploration of the mass and frozen section biopsy to avoid unnecessary orchiectomy. CONCLUSION: The diagnosis of paratesticular Fibrous pseudotumor is challenging. The contribution of scrotal MRI and intra-operative frozen section is essential for therapeutic management.

HPLC-DAD Analysis and Investigation of Biological Properties of the Leaves of Globularia alypum (L.), Infusion Extract.

Globularia alypum L. (GA) belonging to the Globulariaceae family is a Mediterranean plant which is widely used in traditional Tunisian medicine. The aim of this study was to investigate the phytochemical composition, antioxidant, anti-arthritic, antiproliferative, antibacterial and antibiofilm potential of aqueous GA leaf extracts (AGAL). Quantitative analyses of the different constituents of extracts were evaluated by high-performance liquid chromatography with photodiode-array detection (HPLC-DAD). Spectrophotometric methods and chemical tests were used for antioxidant and anti-arthritic activities. The antiproliferative study was evaluated using colorectal cancer SW620 cells, while the antibacterial assessment and analysis of the antibiofilm effects were determined by the microdilution method and the crystal violet assay, respectively. AGAL extracts presented several components, mainly Nepetin-7-Glucoside and trans-ferrulic acid. The results showed that they had an important antioxidant (IC50 = 0.34; 0.38 and 1.20 mg/mL) and anti-arthritic (IC50 = 2.94 mg/mL) properties, and these effects are displayed in a dose-dependent manner. In addition, this extract demonstrated significant antiproliferative (IC50 = 50 µg/mL), antibacterial (MIC = 6.25 mg/mL and MBC = 6.25 mg/mL), and antibiofilm (59.70% at 25 mg/mL) properties especially against S. aureus. The results achieved confirm the important role of this plant as a source of therapeutic activities.

Recurrent hematuria: A rare presentation of leiomyosarcoma of the prostate.

Introduction and Importance: Prostatic leiomyosarcoma is a rare aggressive tumor. The presentation came with non-specific signs and symptoms likewise other forms of prostatic pathology like benign prostatic hyperplasia. Case presentation: A 64 years old man presented to the emergency with a recurrent macroscopic hematuria, he was a heavy smoker and has reported lower urinary tract symptoms. On the physical examination, the patient was hemodynamically stable and afebrile. However, the digital rectal exam revealed an enlarged homogeneous prostate without any palpable nodule. Pelvic transabdominal ultrasound showed an enlarged prostate and a thickening of the bladder's left lateral wall. The CT-scan showed a large and heterogeneous mass arising from the left bladder wall measuring 100 mm, which extends through almost the entire bladder wall. Furthermore, the patient performed cystoscopy, performed by a Urology Professor, showing a normal urethra, a normal prostate gland, and a large solid bladder mass with multiple clots. Subsequently, multiple masses' biopsies were performed. The diagnosis of a primary protatic leomyosarcoma was based on the clinical findings and on the histopathological exam. The patient was prepared for a radical cystoprostatectomy, which would be performed by a Urology Professor, but he died of cardiac arrest before undergoing surgery. Clinical discussion: There are no specific clinical presentations of prostatic sarcoma, patients normally complain of urinary frequency and urinary urgency. Due to the lack of typical clinical symptoms, the tumor is easily overlooked or misdiagnosed as benign prostatic hyperplasia. In this case, the first symptom was a recurrent hematuria in a 64 years-old heavy smoker, which is a relatively rare obvious symptom according to literature. As showed in this case, recurrent hematuria may delay the diagnosis. Concerning the management of prostatic leiomyosarcoma, there are no standard recommendations. Multimodality combination treatments including surgery, pre or postoperative radiotherapy and neo or adjuvant chemotherapy have been used in the management of leiomyosarcoma of prostate. Conclusion: Prostatic leiomyosarcoma poses a unique diagnostic challenge, as clinical presentation alone may not always be suggestive, an unsual clinical presentation as recurrent hematuria must suggest a prostatic leimyosarcoma when associated with urinary frequency and urinary urgency. Histopathological examination and the FNCLCC grading system are essential for the definitive diagnosis. Multimodality treatment regimens including surgery, radiotherapy and chemotherapy are recommended.

Renal cell carcinoma with atypical metastases sites revealed by diabetes mellitus: A case report.

Introduction and importance: Lung, bone, lymph nodes and liver are the most common metastatic sites. This observation presents a metastatic renal cell carcinoma (RCC) with atypical secondary sites and a rare mode of revelation corresponding to diabetes mellitus. Case presentation: We report the case of a 64-year-old woman recently diagnosed with diabetes mellitus. A thoracic parietal nodule was palpated. An uro-CT scan had shown a renal tumor with unusual metastatic sites: pleura, pancreas, and contralateral kidney. The patient underwent a biopsy of the pleural nodule. The pathology report concluded to the diagnosis of clear cell RCC. She had a targeted therapy. Three months after admission, the patient had altered general condition and total hematuria. Clinical discussion: RCC commonly metastasizes haematogenously via renal veins. Atypically, secondary lesions may involve pleura. Such a metastatic site may be of particular interest for percutaneous biopsy, as in our case. The rare metastatic invasion of the pancreas is most likely the cause of the inaugural diabetes in our patient. The controlateral kidney was involved in 1.4% of secondary lesions. For patients with poor prognosis, according to International Metastatic RCC Database Consortium classification, anti-angiogenic treatment is recommended. The median overall survival of patients with poor prognosis is 8 months. Conclusions: Pancreas and contralateral kidney are rare secondary sites of RCC. The clinical expression of pancreas metastatic invasion can rarely fit with diabetes. Metastatic dissemination to these organs is most often associated with an unfavorable prognosis.

The importance of surgical treatment in encrusted cystitis and pyelitis: A case report.

INTRODUCTION: Encrusted cystitis and Encrusted pyelitis are rare chronic inflammatory diseases. Those conditions are commonly caused by the Corynebacterium spp. especially the type D2 which is a gram positive, aerobic, slow-growing, and urea-sliting bacteria with a multi-antibiotic resistant profile. PRESENTATION OF CASE: We report the case of a 62-year-old man with a past history of chronic obstructive pulmonary disease. He was referred to the department of urology for urosepsis. Bacterial culture results were positive to Corynebacterium urealyticum. The diagnosis of encrusted cystitis and pyelitis were highly considered. An adapted antibiotherapy was undertaken using vancomycin during 3 weeks. The patient presented two acute peritonitis : the first was caused by a spontaneous bladder dome rupture which was surgically repaired and the second was caused by a total bladder rupture which required cysto-prostatectomy and bilateral ureterostomy. The post operative outcomes were uneventful. Bacterial urinalysis was negative and total recovery was obtained. DISCUSSION: In the majority of the reported cases, there were no sepsis or peritonitis conditions. Medical treatment by the glycopeptides and urine acidification was sufficient. However in this case, the sepsis condition and the bladder rupture with acute peritonitis made exclusively medical treatment by antibiotics insufficient. Therefore cystectomy associated to conventional antibiotics were able to limit the systemic dissemination of the bacteria and save the patient's life. CONCLUSION: Glycopeptides antibiotics are currently the preferential treatment of encrusted cystitis. In some complicated conditions such as bladder rupture and urosepsis as in this case, radical surgical treatment by cystectomy must be realized early to avoid peritonea and septic shock.