Secreting retroperitoneal latero-aortic paraganglioma revealed by acute abdominal pain: a case report.

We report the case of a retroperitoneal paraganglioma in a 35-year-old man discovered by abdominal pain. The abdomino-pelvic computed tomography (CT) showed a retro-peritoneal latero-aortic mass compatible with a paraganglioma, confirmed by the 24-hour urinary metanephrines and normetanephrines test. After an adequate pharmacological preparation, we decide to perform a laparoscopic resection of the paraganglioma. The surgery went without any complication. Blood pressure and urinary catecholamines were normal after the surgery. Our observation presents the particularity of the mode of discovery which is atypical, as well as the particularity of the therapeutic management, which is the laparoscopic resection of the mass.

Successful conservative management of a spontaneous intraperitoneal urinary bladder rupture secondary to benign prostatic hyperplasia: a case report.

A spontaneous intraperitoneal bladder rupture is a rare, serious and life-threatening surgical emergency of various etiologies, with unspecific clinical presentation, and difficult diagnosis. Surgical treatment is the standard therapy for intraperitoneal bladder rupture; however, there is an increasing tendency toward conservative management in selected patients with favorable characteristics. Herein, we report a rare case of a 65-year-old male patient presented to the emergency department with intraperitoneal bladder rupture following an episode of acute urinary retention due to benign prostatic hyperplasia, and which was successfully managed conservatively with urinary bladder catheterization and antibiotic therapy, without any complication.

Medullary Aplasia Revealing a Metastatic Prostatic Adenocarcinoma.

In this case report, we are reporting the case of a 68-year-old male patient who was admitted in our hospital for unintended weight loss, asthenia, and anorexia. Physical examination showed clinical signs of anemia such as pallor of skin and mucous membranes; hemodynamic parameters were normal. Complete blood count (CBC) analysis showed a pancytopenia with anemia, thrombocytopenia, and leukopenia. BM biopsy was performed, showing a malignant infiltration of bone marrow by a metastatic prostate cancer confirmed by immunohistochemistry. Prostate biopsy confirmed the diagnosis of acinar adenocarcinoma with Gleason score 8 (4 + 4), ISUP grade group 4. Our patient underwent chemical castration using LH-RH analogs in association with second-line hormone therapy by abiraterone acetate. The evolution was good on both the oncological and hematological levels.

Transurethral resection syndrome: A rare complication of intraperitoneal bladder perforation during transurethral resection of bladder tumor.

Transurethral resection (TUR) syndrome is a rare and serious complication of bladder perforation during transurethral resection of bladder tumor (TURBT), secondary to the excessive absorption of electrolytes-free irrigating fluid by extravascular route. Its defined as the combination of clinical cardiovascular and/or neurological manifestations, along with hyponatremia. Herein we report a rare case of 61-year-old patient, who presented a typical and severe TUR syndrome, secondary to intraperitoneal bladder perforation during TURBT, requiring intubation and positive inotropic drugs in the intensive care unit (ICU), and which was successfully managed conservatively. The patient was discharged from the hospital without any complications.

Sarcomatoid carcinoma of the urinary bladder: analysis of five cases and literature review.

Sarcomatoid carcinomas of the bladder represent a tiny part of bladder tumors and are characterized by a high potential for malignancy. Very aggressive and affecting mainly men, these tumors present both a urothelial and sarcomatoid contingent. The treatment of these tumors is not well codified given the rarity of cases reported in the literature, however, it seems that the treatment is essentially based on radical cystectomy with extensive pelvic lymph node dissection. We report the experience of our departement in the management of this type of tumor in a series of five cases collected over a period of 8 years.

Management of the Uncommon Bladder Cancers: A Single-Center Experience over 10 Years.

BACKGROUND: Under the name of uncommon bladder cancers are gathered rare histological entities which represent less than 5% of bladder tumors. There is not a clear and consensual therapeutic management for these entities. PURPOSE: To review a single-institution 10-year experience with rare form of bladder cancers detailing the diagnosis, treatment, and patient outcome. MATERIALS AND METHODS: We performed a retrospective review of 27 medical records of rare bladder cancer form treated at our center between February 2006 and February 2015. The clinicopathologic features are reported with emphasis on treatment and survival. RESULTS: Mean patient age was 65.5 ± 20 yr and 70% of patients were males. Smoking background was found in 16 cases, chronic bladder irritation factors were found in 12 cases, and past urinary tract infection was found in 11 cases. The main symptom was total hematuria (93%) causing an anemia in 16 cases. The two mean histological forms were epidermoid carcinoma (37%) and adenocarcinoma (22%). 26% of patients were found to have extended invasive tumors (T4) at diagnosis. Metastatic disease was confirmed in 8 cases. Our patients were managed by a wide range of therapeutic modalities as total cystectomy with bilateral lymph node dissection (63%), palliative chemotherapy (30%), or concomitant radiochemotherapy (7%). 55.6% of patients were alive one year after diagnosis. Epidermoid carcinoma has the best prognosis followed by leiomyosarcoma and sarcomatoid carcinoma. Neuroendocrine carcinoma has the worst outcome. The overall 5-year survival rate is 33.3%. CONCLUSION: The rarity and small size of these tumors justify the absence of clear and consensual therapeutic management. No role of total cystectomy concerning the conclusions could be drawn but elements suggest this may be the treatment of choice. The highly aggressive nature of those lesions justifies an aggressive and fast therapy when feasible which gives the best outcomes.

Pathogenesis, Diagnosis, and Management of Splenogonadal Fusion: A Literature Review.

INTRODUCTION: Splenogonadal fusion is a rare congenital anomaly, defined by the presence of ectopic splenic tissue caused by an abnormal connection between the spleen and the gonad or mesonephrotic derivatives during the embryonic period. MATERIALS AND METHODS: By reporting an observational case and performing a review of the literature according to the CARE guidelines (using the PubMed database and guidelines from urology, general surgery, and pediatric learned societies), we present the embryological genesis of the splenogonadal fusion, the associated anatomical anomalies, and the diagnostic procedure. Observation. We report the case of a patient aged 45, with no notable history, reporting left testicular pain. A small nodule on the upper pole of the left testicular was clinically palpable. Tumor markers were normal, and scrotal ultrasound depicted a hypoechoic hypervascular nodule measuring 8∗6∗8 mm. After validation in a multidisciplinary oncology consultation meeting and opinion from a uro-andrologist expert, the patient underwent an inguinal lumpectomy with an extemporaneous examination which did not objectify any signs of malignancy. Ultimately, it is a normal spleen tissue in the testicular ectopic position. Discussion. Splenogonadal fusion corresponds to a rare congenital malformation; less than 200 cases have been published in the literature, most often affecting boys, with a sex ratio of 15/1. Two types are described, depending on the continuity of the link between the orthotopic spleen and the gonad: the continuous and discontinuous forms. In a third of the cases, there are associated congenital malformations and particularly in the continuous forms (44 to 50% of the cases): anomalies of the limbs, micrognathia, microgyria, and hepatic and digestive abnormalities. Cryptorchidism is associated with the continuous form in 31% of cases. The preoperative diagnosis remains difficult because of its morphological and clinical characteristics suggesting a tumor process.

Microcystic urothelial carcinoma of the bladder: A case report.

Microcystic variant of urothelial carcinoma was recently added to the World Health organization classification of transitional cell carcinoma. This variant is characterized by its aggressiveness explaining the low long-term survival rate of the patients. Larger studies are needed to determine the adequate treatment course. We present the case of a 71-year-old patient who was diagnosed with muscle invasive microcystic variant of urothelial carcinoma of the bladder and remained free of tumor recurrence two year after surgery.

Multiples deep abscesses: A rare complications of bricker ileal conduit urinary diversion after bilateral stenosis of the uretero-ileal anastomosis.

The most common complications of ileal conduit can be linked to bowel function, uretero-ileal anastomosis, complications related to cutaneous stoma itself and infections in general. It is often suspected upon the discovery of obstructive kidney failure. The management of stenosis of the uretero-ileal anastomosis is delicate requiring first, an attempt by endourological maneuvers for the benefit of less morbidity, while raising that a tumor recurrence is possible specially if it's performed in a tumor context. We report an original observation of a bilateral ureteral stenosis of uretero-ileal anastomosis revealed by an obstructive anuria five years after a radical cystectomy.

Retroperitoneal Ectopic Location of an Intrauterine Device Revealed by Renal Colic: An Exceptional Case.

The intrauterine device (IUD) is one of the most effective contraceptive methods. Its Pearl Index is less than 1 per 100 women. It is the most used method around the world: about 100 million users. However, its insertion can cause certain complications, such as infection, expulsion, or perforation essentially when the rules of use are poorly applied. Perforation remains exceptional but one of the most serious complications. Indeed, after a perforation, the IUD could be located in different neighboring organs. We report a new case of IUD ectopic location in the peritoneal cavity, which was diagnosed 7 years after the insertion and as part of the renal colic assessment. The surgery was performed to remove the IUD which was embedded in the peritoneum and compresses the ureter and causes dilation upstream. To our knowledge, this is the first case reported in the literature of an ectopic location in the retroperitoneal space of an intrauterine device.

Scrotal Skin Metastases Revealing a Prostatic Adenocarcinoma.

INTRODUCTION: Prostate cancer is the most common cancer in men. Cutaneous metastasis from prostate cancer is an unusual clinical finding. Scrotal skin metastasis revealing a prostate adenocarcinoma is even rarer. Case Report. We report the case of a 78-year-old patient, who initially consulted for nonspecific scrotal skin lesions evolving for 4 months. Patient's past history revealed urinary disorders. Physical examination and PSA levels led to perform a prostate biopsy, and the diagnosis of prostate adenocarcinoma was made. Bone scintigraphy showed that the cancer has spread to the bones. Imaging studies showed that the cutaneous lesions were limited to the scrotal wall. Cutaneous metastasis was suspected and was proven on skin biopsy. The patient received second-generation hormone therapy with good clinical and biological outcomes. Discussion. Based on literature review of nearly 2,500 skin metastases, we found that only 436 were spreading from the genitourinary tract. Skin metastasis from prostate adenocarcinoma is a rare entity with a low incidence rate (0.36%). CONCLUSION: Skin metastases, and especially in the scrotum, are exceptional in prostate cancer. However, in any patient with a prostate adenocarcinoma, nonspecific cutaneous lesions should lead to perform skin biopsy in order to identify and initiate treatment of cutaneous metastases.

[Primitive adenocarcinoma of the bladder: about 6 cases]. / Adénocarcinome primitif de la vessie: à propos de 6 cas.

Primitive adenocarcinoma of the bladder is a rare form of bladder tumor accounting for less than 2% of bladder cancers. It mostly affects male sex, with a sex ratio of 3/1 and an average age of onset between 60 years and 70 years. Clinical manifestation is non-specific and dominated by haematuria. Endoscopic resection of the bladder with anatomo-pathological examination allows the diagnosis. Treatment of primitive adenocarcinoma of the bladder is controversial due to the rarity of cases reported in the literature. However, the treatment of choice seems to be radical cystectomy with extended lymphadenectomy. We report a series of 6 cases of adenocarcinoma treated and followed-up in our hospital. Our analysis is based on the evaluation of the epidemiological, clinical, pathological and therapeutic features of adenocarcinoma of the bladder as well as on the study of the evolutionary features and prognostic factors.

Renal Carcinoma and Kartagener Syndrome: An Unusual Association.

BACKGROUND: The association of renal cell carcinoma and Kartagener's syndrome is unusual, and only eleven cases have been reported in the literature. The purpose of this work is to analyze this unusual association of Kartagener's syndrome and renal cell tumor and to study the main diagnostic and therapeutic aspects through our observation and review of the literature. Case Presentation. We report the case of a 50-year-old patient, with a history of recurrent respiratory infections, in whom a renal tumor was simultaneously diagnosed with Kartagener's syndrome, represented by situs inversus, bronchiectasia, and chronic sinusitis. The patient was treated by partial nephrectomy, and the histological examination showed a clear cell carcinoma. Through this observation and a review of the literature, we try to analyze this association as well as the main diagnostic and therapeutic aspects. CONCLUSION: The association of situs inversus and renal cell carcinoma is very rare-preoperative assessment and anatomy knowledge are crucial for a better adaptation of the surgical technique.

Zinner's Syndrome: A Rare Diagnosis of Dysuria Based on Imaging.

Zinner's syndrome is a rare congenital malformation of the seminal vesicle and ipsilateral upper urinary tract, due to developmental arrest in early embryogenesis of the Müllerian duct. Clinical presentation is nonspecific and includes voiding symptoms such as dysuria, ejaculatory disorders, and hypogastric or perineal pain. The diagnosis is made with imaging techniques, notably Magnetic Resonance Imaging (MRI) which remains the gold standard exam for diagnosis confirmation and therapeutic management. Treatment options depend on the severity of symptoms, the size of the cyst, and the complications. Herein, we report a rare case of a 33-year-old young patient who presented recurrent dysuria and ejaculatory disorders for the last 5 years. Imaging studies revealed an empty left renal fossa, with cystic pelvic mass related to the seminal vesicle and which was compatible with the diagnosis of Zinner's syndrome. The patient underwent successful laparoscopic removal of the cyst and seminal vesicle, with total disappearance of urinary and sexual complaints with a 3-year follow-up.

[Squamous cell carcinoma of the bladder: a retrospective study conducted in a Moroccan University Hospital and literature review]. / Carcinome épidermoïde de la vessie: expérience rétrospective dans un hôpital universitaire marocain et revue de la littérature.

Squamous cell carcinoma of the bladder is a rare form of bladder tumor, accounting for less than 5% of bladder cancers. Sex ratio is balanced and the black population is more affected by this disease. It manifests with non-specific clinical symptoms and it is dominated by haematuria. Diagnosis is based on endoscopic resection of the bladder with anatomopathological examination. Treatment remains controversial because of the rarity of cases reported in the literature. However, radical cystectomy with extensive lymph node dissection is the treatment of choice. We here report a series of 10 cases of squamous cell carcinoma treated and followed up in our department. Our study highlights the epidemiological, clinical, anatomopathological, therapeutic and evolutionary features of squamous cell carcinoma as well as its prognostic factors.

[The role of open nephrolithotomy in the treatment of coralliform stones: a series of 53 patients]. / Place de la néphrolithotomie à ciel ouvert dans le traitement du calcul coralliforme: à propos d'une série de 53 patients.

This study aims to discuss the role of open surgery in the treatment of renal lithiasis, including coralliform stones, with the advent of new less invasive techniques. We report a series of 53 cases of coralliform stones whose data were collected in our Hospital during a period of 7 years, from January 2011 to January 2018. The patients underwent open nephrolithotomy by lombotomy. The mean post-operative length of stay was 10 days. The immediate and early postoperative outcomes were simple in 36 patients, 6 patients underwent blood transfusion, 2 had severe sepsis in the postoperative period, 5 had infection of the wall and 4 had urinary fistula, secondarily managed by endoscopic drainage. Residual stones were found in 9 cases (16.9%). Stones were essentially treated by extracorporeal lithotripsy. Late outcomes were characterized by renal atrophy in 2 patients, lithiasic recurrence in 9 patients, an improvement in creatinine clearance in 9 patients and a slight worsening in 5 patients. Open surgery presents the risk of multiple complications and it is not recommended for first-line treatment of renal lithiasis. However it is important to determine which patients would benefit from open nephrolithotomy.

[Bladder leiomyosarcoma: about 3 cases]. / Le léiomyosarcome de la vessie: à propos de 3 cas.

Bladder leiomyosarcoma is a rare highly malignant tumor. It can occur in children and adults with a maximum incidence in patients over 60 years of age. It mainly affects men, with a sex ratio of 3/1. Its clinical features are non-specific and dominated by the haematuria. Endoscopic resection of the bladder associated with anatomo-pathological examination allow the diagnosis. Its treatment remains controversial due to the rarity of cases reported in the literature. Neoadjuvant chemotherapy followed by radical cystectomy is the treatment of choice, if the patient's clinical condition permit. We report 3 cases of bladder leiomyosarcoma treated by radical cystectomy and with uneventful postoperative course.

[Intrauterine device: about a rare complication and literature review]. / Le dispositif intra-utérin: à propos d'une complication rare et revue de la littérature.

The intrauterine device (IUD) is the most common contraceptive method used in the world. Transuterine migration is a rare complication, accounting for 1/350 - 1/10000 insertions in the literature. We report the case of a 40-year old patient, who had had an IUD insertion 12-year before, presenting with pelvic and right lower back pain associated with intermittent hematuria and burning during urination. Radiological assessment showed calcific deposits on intra bladder IUD. The patient underwent cystostomy, without any difficulty, allowing stone and IUD extraction. A urinary catheter was left in place for 5 days and then withdrawn. The postoperative course was uneventful.

[Metastatic paratesticular liposarcoma]. / Liposarcome paratesticulaire métastatique.

We report the dramatic case of a 18-year old patient with immediately metastatic round cells paratesticular liposarcoma. It is a rare tumor that develops in the fatty tissue surrounding the testicle and the spermatic cord. Clinical and radiological signs are nonspecific and diagnosis is usually based on surgical specimen examination. The treatment involves radical inguinal orchiectomy, sometimes extended to adjacent structures. Adjuvant radiation therapy could be used in the case of locally advanced mass or incomplete resection. Despite its slow progression, prolonged monitoring is required due to the high risk of late recurrence.