RESUMO
Acute abdomen caused by spontaneous rupture of the inflammatory myofibroblastic tumor of the urinary bladder (IMTUB) is a rare clinical emergency of the urinary system.It is difficult to distinguish it from spontaneous rupture of bladder caused by other causes before surgery. An emergency case of spontaneous rupture of IMTUB was reported. A 57-year-old middle-aged woman was admitted to the hospital because of "acute lower abdominal pain for 5 hours". No history of smoking and gross hematuria. The physical examination revealed visible abdominal tenderness as well as signs of shock. A pelvic CT scan shows a space-occupying lesion above the bladder with massive accumulation of blood. When the nature of the tumor could not be determined, emergency laparotomy and partial cystectomy were performed, and postoperative pathology confirmed cystitis myofibroblastic tumor. No local recurrence or distant metastasis of the tumor was observed during the regular follow-up period of 6 months. IMTUB should focus on prevention and treatment, with a combination of preoperative examination and postoperative pathology, and finally implement highly individualized treatment.
RESUMO
BACKGROUND: The 2020 European Association of Urology prostate cancer guidelines recommend androgen deprivation therapy (ADT) in combination with apalutamide and enzalutamide, a new generation of androgen receptor antagonists, as first-line therapy. A decrease in prostate-specific antigen (PSA) levels may occur in the early stages of novel hormonal therapy; however, radionuclide bone imaging may suggest disease progression. During follow-up, PSA, radionuclide bone imaging, and prostate-specific membrane antigen (PSMA) positron emission tomography - computed tomography (PET-CT) are needed for systematic evaluation. CASE SUMMARY: We admitted a 56-year-old male patient with metastatic hormone-sensitive prostate cancer. Initial radionuclide bone imaging, magnetic resonance imaging (MRI), and PSMA PET-CT showed prostate cancer with multiple bone metastases. Ultrasound-guided needle biopsy of the prostate revealed a poorly differentiated adenocarcinoma of the prostate with a Gleason score: 5+4 = 9. The final diagnosis was a prostate adenocarcinoma (T4N1M1). ADT with novel hormonal therapy (goseraline sustained-release implant 3.6 mg monthly and apalutamide 240 mg daily) was commenced. Three months later, radionuclide bone imaging and MRI revealed advanced bone metastasis. However, PSMA PET-CT examination showed a significant reduction in PSMA aggregation on the bone, indicating improved bone metastases. Considering that progressive decrease in the presenting lumbar pain, treatment strategies were considered to be effective. CONCLUSION: ADT using novel hormonal therapy is effective for treating patients with prostate adenocarcinoma. Careful evaluation must precede treatment plan changes.
RESUMO
Choriocarcinoma is a cancer that usually occurs in the uterus during pregnancy. Although choriocarcinoma with renal metastasis and spontaneous renal hemorrhage is very rare, it can occur. We describe a rare case of metastatic choriocarcinoma, wherein the patient presented with acute abdominal pain due to a subcapsular hematoma secondary to a bleeding renal metastasis. We performed a laparoscopic nephron sparing surgery to remove the tumor and control the bleeding. A retrospective analysis revealed that metastasis was detected on 18F-fluorodeoxyglucose PET/CT, but not on CT alone. To our knowledge, a case of choriocarcinoma with such symptoms and treatment has not been described in recent literature. Our case illustrates that acute bleeding from a renal metastasis can be effectively managed by laparoscopic nephron sparing surgery. It also demonstrates the advantage 18F-FDG PET/CT may have in the evaluation of metastatic choriocarcinoma.