[Giant stone complicating calyceal diverticulum]. / Calcul géant compliquant un diverticule caliciel.

Calyceal diverticulum is acystic cavity in the renal parenchyma, communicating with the collecting system via an infundibulum. In more than 40% of cases it is associated with a stone and in most cases appears as milk of calcium forming a fluid level or multiple small stones. We here report the case of an 82-year old patient with no previous history, presenting with mild and intermittent right flank pain lasting for 8 years. Clinical examination was normal. The patient first underwent X-ray of urinary tree without preparation showing a density of calcium projecting into the upper pole of the right kidney (A). The patient then underwent uroscanner showing giant stone measuring 28mm within a caliciel diverticulum of the upper pole directly communicating with the renal pelvis (B). No associated urinary tract infection or haematuria were detected. Given patient's age and that he was paucisymptomatic and uninfected, therapeutic abstention and monitoring were indicated. In accordance with the recommendations of the experts, only symptomatic intradiverticular stones must be treated. First, extracorporeal shockwave lithotripsy (ESWL) allows improvement to the symptoms in 1 patient out of 2 and no stone fragmentation in 1 patient out of 4. In second intention, flexible uretero-renoscopy should be performed. Percutaneous nephrolithotomy can be performed if the stone is located in the lower pole (rare). Finally, in case of failure, laparoscopic treatment or open surgery may be proposed.

[Malignant renal epithelioid angiomyolipoma (EAML): about a rare case]. / Angiomyolipome rénal épithélioïde malin (AREM): à propos d'un cas rare.

Malignant renal epithelioid angiomyolipoma (EAML) is a rare disease which has long been considered a hamartomatous lesion. Positive diagnosis is purely based on immunohistochemical investigation. Microscopically, it is characterized by mononuclear epithelioid cells showing a clear cytoplasm with severe cytonuclear atypies and expressing smooth muscle cell markers and melanocytic markers (HMB 45). We here report a rare case of EAML diagnosed after anatomopathological examination of a retroperitoneal tumor whose origin wasn't predetermined by CT scan.

[Cavernous metastasis from blader tumor]. / Métastase caverneuse d'une tumeur de vessie.

The incidence of cavernous metastases after radical treatment for bladder tumor is exceptional and is approximately 1%. The mean time between surgery and the occurrence of metastases is 8 months. In some cases they occur after 10 years. Diagnosis is confirmed by biopsy, which shows their urothelial origin. Here we report the case of 56-year old patient, with a history of smoking, having undergone total cystoprostatectomy in January 2017, who presented 2 months later with induratio penis plastica with no other sign associated. Priapism and gangrene of the penis of infectious origin have been suspected but, given the patient's clinical condition, the more likely diagnosis was cavernous metastasis. On two occasions the patient refused biopsy: during two consultations at 15 days interval (A, B). The patient accepted to undergo biopsy during the 3th consultation (C, D). Biopsy confirmed the diagnosis of cavernous metastasis.

[Kaposi's sarcoma of the penis in a HIV-seronegative patient]. / Sarcome de kaposi penien chez un patient seronegatif.

Sarcomas of the penis account for less than 5% of all tumors of the penis. They are dominated by Kaposi's sarcoma that mainly affects HIV-positive patients. However, recent studies have shown a relationship between Kaposi's sarcoma and HHV-8 infection (Human herpes virus-8), which explains why this sarcoma occurs in non-immunocompromised and HIV-seronegative patients. We here report the case of a 72-year old patient, with no previous medical history, reporting of gradual onset of tumor-like granulation tissue of 3 years duration at the level of the gland, without secondary location. Given the patient's clinical condition, epidermoid carcinoma or sarcomatoid carcinoma of the penis were suspected. Initial biopsy was negative, the second was in favor of Kaposi's sarcoma, confirmed by immunohistochemistry. The patient underwent chemotherapy.

[IIA2-Y-type urethral duplication]. / Duplicité de l'urètre de type IIA2 en "Y".

Urethral duplications are extremely rare congenital malformations. The most used classification is that of Effmann and Lebowitz, describing 6 types of urethral duplications. The under type IIA2-Y is one of the most rare duplications corresponding to duplicated urethra originating from the bladder neck and extending toward the ectopic perineal or anal insertion. We here report the case of a 32 year patient, with no previous personal history, suffering from urinary leakage during and after urination since childhood. Clinical examination showed a bottleneck at the level to the perineum initially suggesting urethral fistula. However, the absence of fistula-associated urinary disorders as well as urinary leakage since childhood refuted this assumption. The patient underwent Micturating Retrograde Urethrocistography after perineal orifice catheterization confirming well systematized tract. Surgical exploration was based on excision of the duplicate urethra after hydrophilic catheterization by inserting hydrophilic guidewire up to its anastomosis at the level of the prostate. The examination of the surgical specimen confirmed the diagnosis of supernumerary urethra.

[Urethral ectropion may hide a carcinoma!] / Un ectropion urétral peut cacher un carcinome!

The incidence of female urethral cancer is rare and accounts for 0.02% of all women's cancers. It is dominated by epidermoid carcinoma, which most commonly develops in the distal portion of the urethra, extending to inguinal lymph nodes. The diagnosis is confirmed in the distal forms on the basis of uretrocystoscopy with biopsy. Abdominopelvic MRI allows to determine tumor extension as well as its infiltration into tissues and peri-urethral organs. As in superficial tumors of the distal urethra, simple circumferential resection of the urethra associated with resection of the adjacent portion of the anterior surface of the vagina is sufficient. We here report the case of a 59-year old diabetic and hypertensive female patient presenting for irritative lower urinary tract symptoms, associated with vulvar mass. Clinical examination showed mucosal ectropion extending from the urethral meatus associated with extensive local inflammation. The patient underwent wide excision of the ectropion which was diagnosed as squamous cell carcinoma. Abdominopelvic MRI was normal.