Primary peripheral neuroectodermal tumor or Ewing's sarcoma of the kidney: A rare case and review of the literature.

Peripheral neuroectodermal tumors (PNET), or Ewing sarcoma, are tumors that generally develop in bone; extraskeletal locations are rare. Renal PNETs are rare and are characterized by an aggressive clinical course and a poor prognosis. We report the case of a young patient who presented with abdominal and lumbar pain with a palpable abdominal mass. The imaging was in favor of a huge renal tumor, and the histological analysis allowed the diagnosis of a renal PNET. The therapeutic attitude was multimodal, including surgery and chemotherapy, allowing complete remission and a favorable outcome.

A synchronous presentation of thyroid follicular carcinoma-like renal tumor and papillary vesicular thyroid tumors: About an exceptional case and review of the literature.

INTRODUCTION: Thyroid follicular renal cell carcinoma is a special type of renal cell carcinoma newly recognized in recent years. The data is not mature due to the rarity of cases. The association of vesicular papillary tumors of the thyroid is exceptional, and this is the first publication describing such an association in the literature. CASE PRESENTATION: We present the case of a patient who consulted for a goiter. The definitive pathological examination of the specimen of the thyroidectomy showed papillary vesicular thyroid tumors. A month later, she presented with total hematuria; the CT scan revealed a left renal mass; the patient underwent a partial nephrectomy; and the definitive pathological examination of the specimen showed a thyroid follicular carcinoma-like renal tumor. DISCUSSION: Thyroid-type follicular cell renal cell carcinomas are currently recognized as a distinct entity whose histological appearance is reminiscent of thyroid vesicular lesions. There are currently around 39 cases in the literature, but no concomitant thyroid localization has been observed. This finding cannot be verified in the absence of a systematic histological study of the thyroid gland. Our case invites discussion of other thyroid investigation modalities, in particular the value of thyroid biopsy versus cytopuncture, which is often inconclusive in this type of situation. CONCLUSION: At present, understanding of TFCLRT is still very limited. Even more so, their association with a thyroid tumor is exceptional in the literature. We need to increase the number of cases and conduct in-depth investigations with longer follow-up periods to better understand the situation.

Role of preoperative neutrophil to lymphocyte ratio in prediction of recurrence, progression, and BCG failure in non-muscle invasive bladder cancer: a retrospective study.

Introduction: neutrophil/lymphocyte ratio (NLR), as a biomarker of the systemic inflammatory response, has been studied for diverse tumors. Our study aims to determine whether the NLR can be reliably used as a tool to predict disease course in patients diagnosed with primary non-muscle invasive bladder tumors (NMIBC). Methods: a retrospective study between 2009 to 2014 was conducted on 300 patients newly diagnosed with NMIBC at our institution. The cut-off value of NLR was set at 2.5. Survival curves were compared using the log-rank test. The association between recurrence, progression, and NLR was assessed univariate, and the prognostic significance of high NLR was assessed using multivariate analysis. Results: one hundred and seventy-five patients had an NLR <2.5 and 125 patients had an NLR ≥ 2.5. The survival rate with recurrence at 5 years was higher in the group with an NLR >2.5 (p<0.001, 35 vs 18 months), similarly, the survival rate with progression at 5 years was higher in the group with an NLR > 2.5 (p=0.001, 36 vs. 27 months). The failure rate of immunotherapy using BCG was higher when the NLR was over 2.5. In a multivariate analysis, the factors associated with recurrence were NLR>2.5 (HR=2.03, 95% CI=1.32-3.11, p=0.001), pathologic stage pT1 (HR=2.42, 95% CI=1.52-3.85, p=0.001), high-grade (HR=1.76, 95% CI=1.52-3.92, p=0.01), concomitant CIS lesions (HR=2.31, 95% CI=1.36-3.92, p=0.001), presence of lymphovascular emboli (HR=5.77, 95% CI=1.77-18.78, p=0.004), and BCG immunotherapy failure (HR=5.29, 95% CI=2.88-9.70, p=0.001). With regard to progression, in a multivariate study, the significant factors were NLR>2.5(HR=2.91, 95% CI=1.17-7.23, p=0.01), BCG immunotherapy failure (HR=5.68, 95% CI=3.16-10.22, p=0.001), and the presence of lymphovascular emboli (HR=5.01, 95% CI=1.50-16.05, p=0.001). Conclusion: preoperative NLR value could predict recurrence, progression, and failure of BCG immunotherapy in NMIBC patients.

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.

Laparoscopic Management of an Inflammatory Pseudotumor Mimicking a Locally Advanced Renal Carcinoma: A Diagnostic Pitfall.

Inflammatory pseudotumors of the kidney are an infrequent entity. More frequently described in the lung, the genitourinary tract location is rare. Commonly described in the bladder, the kidney damage remains exceptional. Herein, we report the case of 60 years old man with a history of flank pain, initially diagnosed with a locally advanced left renal carcinoma invading the left colon. Then, after performing a laparoscopic radical nephrectomy, the histopathological diagnosis of inflammatory pseudotumor of the left kidney has been made.

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.

[Buschke-Lowenstein tumor of the penis]. / Tumeur de Buschke-Lowenstein à localisation pénienne.

Buschke-Lowenstein (BLT) tumor or giant condyloma acuminatum (GCA) is a rare viral disease belonging to the group of verrucous carcinomas; the virus responsible is human papilloma virus (HPV) type 6 and 11 which is transmitted in humans by sexual contact. It is characterized by its extension within the surface layer and at depth, by its degenerative potential and by its recurrent nature after treatment. Therapy is based on surgery. We report the case of a 53-year old patient with a history of recurrent urethritis and a multiplicity of partners without homosexual encounters, presenting with a lesion at the level of the penis. The symptoms started three years before and were caused by a nonpainful budding tumor growing gradually at the level of the root of the penis resulting in tingling and bleeding. Clinical examination showed a dyschromic, infiltrating, cauliflower-like, papillomatous tumor measuring 13cm along its longer axis on the dorsal surface of the penis, with patchy ulcers and extending to the suprapubic region. The remainder of the clinical examination was normal and the assessment of sexually transmitted infection (STI) was negative. Treatment was based on complete surgical resection of the tumor. Soft tissue was covered by the surrounding skin. The anatomopathological study showed a giant genital wart without signs of malignancy. The postoperative course was uneventful. The patient didn't develop tumor recurrence during a 5-year follow-up period.

A rare complication of the AMS Advance™ male sling system for the treatment of stress urinary incontinence: A case report.

Radical prostatectomy is the most common reason for male stress urinary incontinence. It affects around 10% of operated patients and can have a major impact on the quality of life of patients and affect various daily activities. There is still insecurity about its therapeutic management. We report the case of a 72-year-old patient, who underwent a radical prostatectomy 10 years ago, complicated by moderate post-operative urinary incontinence motivating the placement of an Advance sub-urethral sling, who presents for dysuria with micturition burns, the urethral fibroscopy objectify the presence of an erosion of the urethra by the sling under urethral.

Spontaneous Intraperitoneal Rupture of Bladder Diverticulum: A Rare Cause of Peritonitis.

Spontaneous rupture of acquired bladder diverticulum in an adult patient is an extremely rare pathological entity with only 15 cases reported in the available literature. Etiologies are dominated by bladder outlet obstruction, represented mainly by benign prostatic hypertrophy (BPH) in elderly men. Clinical presentation is nonspecific, leading to delayed diagnosis and treatment. Surgical management is the standard approach for intraperitoneal rupture of bladder diverticulum. The prognosis depends on the earliness of treatment, associated comorbidity, and the nature of underlying diseases. Herein, we report a rare case of a 65-year-old male patient, who presented a spontaneous rupture of a large acquired bladder diverticulum, secondary to acute urinary retention complicating benign prostatic hypertrophy. The diagnosis was suspected in the presence of generalized peritonitis associated with lower urinary tract symptoms (LUTS) and was confirmed accurately and promptly by a computed tomography (CT) of the abdomen and pelvis. The patient underwent a successful surgical excision of the diverticulum and bladder repair without delay. The postoperative course was uneventful, and he was discharged from the hospital without any complication.

Epididymo-testicular ischemia without torsion.

Epididymo-testicular infarction associated with ischemia of spermatic cord without torsion secondary to an orchiepididymitis is an extremely rare pathological entity, of little known etiopathogenesis and idiopathic in the majority of cases. The authors report an original observation of a 23-year-old young patient with a history of untreated orchiepididymitis, which presented to the emergency department for testicular pain. The ultrasound has showed an ischemic testicle and the exploratory scrototomy objectified an epididymo-testicular necrosis associated with ischemia of spermatic cord without torsion. This case highlighted the interest of early diagnosis and effective treatment of orchiepididymitis to prevent this rare serious complication.

Early post-traumatic renal vascular hypertension a rare complication of severe renal trauma.

Severe renal trauma is a particular entity, although rare, but most often involves the risk of short-term death from hemorrhagic shock and long-term death from infectious complications or secondary renal dysfunction, exceptionally post-renal vascular hypertension. Which is generally a late complication, we will report the case of a patient suffering from grade v renal trauma with early post-traumatic renal vascular hypertension, suppressed by medical treatment, then the surgical indication was kept in the second phase in front of a mute kidney.

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.

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.

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 benign retrovesical schwannoma: an extremely rare tumor, a case report]. / Schwannome benin primitif retrovesical: une tumeur très rare à propos d'un cas.

Schwannoma is usually a benign tumor of nervous origin arising from Schwann sheath cells. It is an extremely rare tumour because of its low incidence and its retrovescical localization. Histological and immunohistochemical examinations confirm the histological type as well as the benign or malignant origin of schwannoma. Because of the risk of recurrence and malignant transformation, excision must be complete. We report the case of a 39 years old patient, hospitalized for chronic pelvic pain accompanied by a sensation of heaviness, lower urinary tract irritation and urinary hesitancy. Diagnostic imaging (ultrasound, CT scan, MRI) of the pelvis showed a left-lateralized retrovescical mass with a thin wall, measuring 68x70x70 mm exerting mass effect on the bladder and the sigmoid. The surgical procedure, a midline laparotomy, allowed the removal of a well encapsulated retrovesical mass. Histological and immunohistochemical examinations concluded to a benign schwannoma. Recidivism and malignant transformation, although rare after surgery, impose postoperative clinical monitoring and annual CT scanning.